"...drop off voluntarily" is a euphemism for losing coverage
25
Sen. McM. has thoroughly abused his role and position as Majority Leader. One onders why his own state has not already recalled him. A Agentleman perhaps, but a political THUG. If baring hearings on Just Garland for the SCOTUS seat that should have been his was not enough, McM has tried to rape the Affordable Care Act - In Private, and issue back-channel direction to some members of SCOTUS. Whille AJ Gorsuch *may* be an honorable fellow. he has ZERO right to the seat currently supporting his posterior at the SCOTUS bench; in short, he should NOT be there. As a young man, how long will he remain - and how much damage can he do? One or two more seats may become available and before #45 can be unseated. How much more damage can be done before #45 is removed - by whatever means are required? I don't know. All legitimate means require time and I R/O nothing except violence, which is never a viable option. The fool wearing the #45 badge must go and the sooner the better.
16
A mistake for the Republican party is worse than a crime? Is that what I just read?
13
Having your own insurance shouldn't be "voluntary" it's a matter of taking personal responsibility and paying your medical bills. Who will if you don't, the tooth fairy? Try telling that to the cops after you've caused an accident that you didn't think you should 'have to' buy car insurance
21
True, eliminating the mandate would lead to less coverage.
So we have another "solution" based on politics and ignorance rather than data and good policy.
So we have another "solution" based on politics and ignorance rather than data and good policy.
17
I watched part of the Young Turks tonight and they said, there will be no Republican healthcare plan voted on, ever. I got a notice from one of the
fund raisers that I must donate today to stop the Republican healthcare bill from passing because the Koch brothers were determined to pass it. There was a picture of the Koch brothers and underneath it said was " Repeal Obama care Now!" Nothing about implementing the Republican health care plan now. All the Republicans have to do to satisfy their wealthy owners, i mean donors, is cut their taxes, and repealing Obama care would take care of that. Oh they will say that they will be working on a new and better plan and even invite the democrats in and then take years and blame the Democrats when it never happens. As an American, I never dreamed I would live in a nightmare like Nazi Germany, and as well worn as this comparison is,
how foolish of me for thinking it could not happen here. We are now governed by killers. I am a senior and would like to volunteer for a brigade forming to help people if there is an emergency, and as fit as I am, I am not nimble as this stalwart group requires and it breaks my heart not to be able to help my fellow citizens if there is a revolution, it will be all I can do to get my disabled son and cats to safety, but my heart is with these young people who are trying to look ahead and prevent more deaths.
fund raisers that I must donate today to stop the Republican healthcare bill from passing because the Koch brothers were determined to pass it. There was a picture of the Koch brothers and underneath it said was " Repeal Obama care Now!" Nothing about implementing the Republican health care plan now. All the Republicans have to do to satisfy their wealthy owners, i mean donors, is cut their taxes, and repealing Obama care would take care of that. Oh they will say that they will be working on a new and better plan and even invite the democrats in and then take years and blame the Democrats when it never happens. As an American, I never dreamed I would live in a nightmare like Nazi Germany, and as well worn as this comparison is,
how foolish of me for thinking it could not happen here. We are now governed by killers. I am a senior and would like to volunteer for a brigade forming to help people if there is an emergency, and as fit as I am, I am not nimble as this stalwart group requires and it breaks my heart not to be able to help my fellow citizens if there is a revolution, it will be all I can do to get my disabled son and cats to safety, but my heart is with these young people who are trying to look ahead and prevent more deaths.
18
". . . “repeal” (really just the reform) . . ." Let the rebranding begin; it's what R's do best. Bumper stickerism.
9
What other thoughts are there for every GOP plan other than appalling greed, dishonesty, and hypocrisy on a grand scale? Ross, you pretend to be a notch above these sewer rats so maybe it's time to call them out on what everyone can see and stop trying to pretend there's any policy or heaven forbid intellectual honesty behind their attempts to throw millions of people off health care. Unless you truly are a fool, you don't believe the market is appropriate for health care.
17
Yes, just a few more chutes, falling weights, hamsters on treadmills and tipping buckets of water and we'll finally have a working Rube Goldberg health care system.
Honestly, Ross, suppose you quit designing these pratfalls and do the right thing instead. Just ask Singapore and Switzerland what that is and you're done.
Honestly, Ross, suppose you quit designing these pratfalls and do the right thing instead. Just ask Singapore and Switzerland what that is and you're done.
14
Easy for your to say, Ross, with your pseudo "quick-fix" answers here. Those Medicaid people will still be hurt badly, the pre-existing condito=ions people and th elderly in nursing homes, and your facile solutions do not help them.
16
Cruelty is never timid
10
Try writing about health care sometime.
10
Russ, do you even understand how the basic principles of insurance work? Giant pool that spreads the risk. Again you take old conservative tropes that NEVER work, and spout them again. For profit healthcare is an oxymoron, and high risk pools don't work. Choice my patooty. Repubs are the party of childish "don't tell me what to do" babies at the expense of many fellow citizens and human lives. Where or where has compassion gone? It's certainly missing in Repubs.
25
You're so casual with people's lives, Mr. Douthat. I suspect you have access to good insurance and the means to pay premiums and out of pocket costs. Not everyone is so lucky. Try to put yourself in the shoes of someone currently battling a serious illness with the help of insurance through the exchange. How secure do you think that person feels? Fighting for one's life and wondering if the GOP is going to pull the plug on one's access to treatment. You're as cruel as our so-called leaders.
22
Douthat's "principled Liibertarianism" is the right to use the emergency room as a walk-in clinic. Grow up and stop listening to Rush, Ross.
23
So the poor and vulnerable (elderly, disabled, vets, etc.) are the sacrificial lambs in your scheme. Very restrained, hah!
15
I try to read your writing because we are polar opposites in our views. And I know I have read/heard that it is good to expose yourself to the ideas of the other side. I agree. But, in this case, as in many others, I fail to grasp why the idea that "The Free Market," an idea championed by NEO-LIBERALS will rise to the occasion and solve all our woes. It does not., and obviously my woes are not your woes! The more the research and the data and the experimenting prove that it does not work, the more entrenched in official policy it becomes. Talk about banging your head against the wall! Or cutting off your nose to spite your face. Or lets all jump into the fire. Enough. Please enough. And enough of Mitch McConnell and John Thune and John Barasso smirking faces. I hate them. All of them. Dark Age Ahead, absolutely.
15
When the people you will kill by pricing insurance beyond their means start dying, will you admit you were wrong?
16
Mr. Douthat doesn’t seem to have met anyone who has been downsized, or been freelance and without a paycheck for many months, or developed a health problem that left them unable to work full-time temporarily. If you get sick, you can’t pay your health care premiums unless you’ve got headroom on your credit cards or savings, which just makes your financial situation more precarious—and you may end up losing your health care. Should you be punished for trying to get it back once you do scrape up the money for coverage?
Or, you drop health care because you’re healthy, young, and have erratic income because you work in the “gig economy” and have to put food, shelter, transportation to work, student loan payments, and actual health care including dentistry ahead of something so abstract as catastrophic health care premiums. In this case, you should be punished for not being able to afford health care and punished if you try to get it back while you're still healthy and working?
Freelancers buying on the private market are going to be a bigger part of the economy in years to come, and the pieces of the puzzle—HSAs, premiums, deductibles, subsidies, punitive tax bills for those who can’t afford high premiums and deductibles even just for catastrophic care or
who underestimate income—have to be understood and addressed. How many politicians have the slightest clue how all of this works?
Or, you drop health care because you’re healthy, young, and have erratic income because you work in the “gig economy” and have to put food, shelter, transportation to work, student loan payments, and actual health care including dentistry ahead of something so abstract as catastrophic health care premiums. In this case, you should be punished for not being able to afford health care and punished if you try to get it back while you're still healthy and working?
Freelancers buying on the private market are going to be a bigger part of the economy in years to come, and the pieces of the puzzle—HSAs, premiums, deductibles, subsidies, punitive tax bills for those who can’t afford high premiums and deductibles even just for catastrophic care or
who underestimate income—have to be understood and addressed. How many politicians have the slightest clue how all of this works?
63
The problem with your plan is about those (a lot) earn enough to pay but won't, and then rapidly will qualify for Medicaid, so there will be no waiting period or penalty for not contributing before.
Very conservatively fair.
Very conservatively fair.
6
We all know the Republican "health-care plan" is first and foremost a tax cut for the wealthy.
45% of the tax cuts go to the top 1%.
Put another way, with 100 people, for every $100 of tax cuts, $45 will go to one person, the other 99 people will share the remaining $55.
45% of the tax cuts go to the top 1%.
Put another way, with 100 people, for every $100 of tax cuts, $45 will go to one person, the other 99 people will share the remaining $55.
15
Make it mandatory that any health care bill McConnell and the rest of the republicans give us that health care bill will be what they receive for the length of their term!
If they live they can run for office again but never receive more then we do.
EVER.
If they live they can run for office again but never receive more then we do.
EVER.
33
You can't drop the individual mandate and keep "blind" insurance coverage. If we don't push younger, healthier people into the insurance pool it is impractical to expect insurers to cover pre-existing conditions and provide community rating for the cost of insurance rather than individual rating on one's past medical history. The individual mandate is unpopular but I think the return to discrimination in healthcare based on medical history would be worse.
24
Just won't give up the ghost will you. Oh ya its simple just pretend that people won't want health insurance and call it choice and freedum!
Universal health care sir saves. But then that would disprove the profit motive.
This article is craven. An arrogant vulture with all the answers for the soon to be cadaver of a society. Thanks for the wisdom.!
Universal health care sir saves. But then that would disprove the profit motive.
This article is craven. An arrogant vulture with all the answers for the soon to be cadaver of a society. Thanks for the wisdom.!
37
Love Mr. Douthat's wonky, euphemistic description of his slashing of funding for Medicaid,
25
You can obfuscate and rename, twist, and word salad all you want in order to hide the basic unadorned fact that the bill transfers millions in tax breaks to the wealthy on the backs of the poor, elderly, children,and the disabled. Your GOP are heartless, cruel, and despicable.
36
And all those who were screaming "death panels" in 2010, probably the same who were spitting at first lady HRC (when she tried much earlier to give us the kind of healthcare everybody else in the developed world have been getting for decades), where are they now? Did they simply switch side overnight like in Orwell's 1984? Will they please make up their mind, get informed and stop watching FakesNews and friends!. We the people are responsible for this abomination called trump and his "modern" version of world wrestling federation presidency. We the people bear full responsibility for transforming our great nation into the United republicans of Banana States. Happy 241st America!
22
Gobbledygook. The GOP hasn't a clue how to fix healthcare because they hate it. The very idea of helping fellow citizens from the misery of illness or accident is anathema to the GOP.
The only consideration for republicans, outside of tax cuts for the rich, are profits, how much big pharma can gouge, big med can charge, and big insurers can deny.
Please spare us your wishy-washy hand wringy attempt to rationalize anything the republicans are doing on healthcare for Americans. It's just another theft of a piece of the Obama legacy and an empty promise. It is also a cruel hoax on the public and an immoral outrage.
You should be ashamed to associate yourself with the GOP, now or ever.
The only consideration for republicans, outside of tax cuts for the rich, are profits, how much big pharma can gouge, big med can charge, and big insurers can deny.
Please spare us your wishy-washy hand wringy attempt to rationalize anything the republicans are doing on healthcare for Americans. It's just another theft of a piece of the Obama legacy and an empty promise. It is also a cruel hoax on the public and an immoral outrage.
You should be ashamed to associate yourself with the GOP, now or ever.
34
I support the elimination of the federal tax mandate. I do not want my dollars to go to supporting wars in the middle east, the entire military/industrial complex and the subsidies to international corporations. I would support federal taxes helping the wounded, sick and dying. I think we have a piece of that puzzle............Medicare.
22
I just don't understand my country, which - by the way - I love.
If you love somebody, you care for them...since we're human, we ALL of us benefit from health care, even the health care of OTHERS around us...because the healthier we ALL are physically, the healthier we ALL have a chance of being mentally...and the healthier we are mentally AND physically, the more ABLE we are to hold down jobs, take care of our families, provide assistance to our neighbors in need, and CONTRIBUTE to society instead of becoming a so-called "drain" on it.
When ALL of us are stronger physically...stronger mentally...stronger emotionally...stronger educationally...stronger economically...the stronger we as the UNITED States of America - a nation - can be...and isn't that good for economic growth?...isn't that good for national defense?...isn't that good for America's place in the world?
Until we ALL care for ALL of us - man, woman, rich, poor, straight, gay, full-bodied, disabled, black, white, grey, yellow, green, whatever - we will not be a great, or STRONG, nation...and that leaves us open to being taken down either by forces outside of ourselves (other nations) or by forces within our own communal body (such as the ultra-rich, who deem their own wealth to be more important than the strength of the nation as a whole).
America does not need to go "small" on health care - it needs to go LARGE!
Loving America means you must LOVE Americans...and you care for those you love, whatever the cost.
If you love somebody, you care for them...since we're human, we ALL of us benefit from health care, even the health care of OTHERS around us...because the healthier we ALL are physically, the healthier we ALL have a chance of being mentally...and the healthier we are mentally AND physically, the more ABLE we are to hold down jobs, take care of our families, provide assistance to our neighbors in need, and CONTRIBUTE to society instead of becoming a so-called "drain" on it.
When ALL of us are stronger physically...stronger mentally...stronger emotionally...stronger educationally...stronger economically...the stronger we as the UNITED States of America - a nation - can be...and isn't that good for economic growth?...isn't that good for national defense?...isn't that good for America's place in the world?
Until we ALL care for ALL of us - man, woman, rich, poor, straight, gay, full-bodied, disabled, black, white, grey, yellow, green, whatever - we will not be a great, or STRONG, nation...and that leaves us open to being taken down either by forces outside of ourselves (other nations) or by forces within our own communal body (such as the ultra-rich, who deem their own wealth to be more important than the strength of the nation as a whole).
America does not need to go "small" on health care - it needs to go LARGE!
Loving America means you must LOVE Americans...and you care for those you love, whatever the cost.
26
Hey news media, Health Care is not an entitlement, it's a program we all pay into over our career as debt slaves in the good old USA. We also pay countless hidden taxes disguised as fees every time we take a breath; which may be taxed soon as well, air that is. As we all sit and watch Trump and his posse of the ignorant and clueless destroy and rape the country we are paying the salaries of these clowns who are working to kill us all. Trump is a tool of the GOP tools who live and breath ignorance and have no idea what it is to be human. They are all crooks. Why are we paying for our own destruction? It seems clear our elected stooges feel Trump is representing the US well with his tremendous grasp of ignorance. Basically we pay taxes so our leaders can start and justify more pointless wars against another manufactured enemy so the weapons makers and their shareholders can Profit From War which is the name of the game in the USA. Lie, start a war and make some coin. Yes the USA is now the biggest joke in history. "Nature Bats Last" and I'm thinking grand slam. Thanks Trump! "My way of joking is to tell the truth. That's the funniest joke in the world." Muhammad Ali
12
"Seven years ago ... [the] sweeping health care bill was increasingly unpopular — the subject of angry town hall protests"
1. The Affordable Care Act never was "sweeping" ... it was designed to be incremental: see
https://newrepublic.com/article/96033/romney-obamacare-adviser-gruber-ki...
2. The Affordable Care Act was never unpopular ... misconceptions about the act were unpopular. Remember "death panels"?
Mr. Douthat makes two errors in his first two sentences, which it not surprising for the President but which has got be be some kind of record for the New York Times.
1. The Affordable Care Act never was "sweeping" ... it was designed to be incremental: see
https://newrepublic.com/article/96033/romney-obamacare-adviser-gruber-ki...
2. The Affordable Care Act was never unpopular ... misconceptions about the act were unpopular. Remember "death panels"?
Mr. Douthat makes two errors in his first two sentences, which it not surprising for the President but which has got be be some kind of record for the New York Times.
16
You make a classic error. You move immediately to details of the proposed bill without saying what problem you are trying to solve.
Are you trying to solve a problem of people without insurance and access to regular healthcare services?
Are you trying to solve a problem of high healthcare costs?
Are you trying to sole a Republican image problem?
Are you trying to solve a problem of shortage of lobbying payments by healthcare device makers?
How should your suggestions be evaluated?
Are you trying to solve a problem of people without insurance and access to regular healthcare services?
Are you trying to solve a problem of high healthcare costs?
Are you trying to sole a Republican image problem?
Are you trying to solve a problem of shortage of lobbying payments by healthcare device makers?
How should your suggestions be evaluated?
14
Why is the mandate hated? You must buy car insurance.
It is hated because of people like you. People like you who want to float all our treasure to bad people (like Trump) who don't need it.
Conservatism is the problem, not an insurance mandate.
It is hated because of people like you. People like you who want to float all our treasure to bad people (like Trump) who don't need it.
Conservatism is the problem, not an insurance mandate.
15
Ross Douthat has a point. It's not necessary to blow up Obamacare. Scott Pruitt at the EPA is well on his way to killing many people with Making Pollution Great Again. Betsy DeVos will dumb down America enough to keep their voters in line.
16
Mitch McConnell, the Masn of a Thousand Faces. And each of them dumber looking than another. But, he also has that smug look, like he always putting something over on someone. And, in this case: It's US!
Mitch is set: He has his own Cadillac Health Care Plan, and his father-in-law is one of the wealthiest billionaires in Taiwan. So, what does he care about Health Care for Americans who really, really need it?
Besides, its time to Balance Tha Budget, play the Wheel of Fortune Game--stealing from the poor, so Mega-Billionaires can get those Bush Tax Cuts back. Ab=nd besides--those Walls, down on the Border don't grow on trees!
"What, Mitch Worry?"
https://thetruthoncommonsense.com
https://thetruthoncommonsense.com
Mitch is set: He has his own Cadillac Health Care Plan, and his father-in-law is one of the wealthiest billionaires in Taiwan. So, what does he care about Health Care for Americans who really, really need it?
Besides, its time to Balance Tha Budget, play the Wheel of Fortune Game--stealing from the poor, so Mega-Billionaires can get those Bush Tax Cuts back. Ab=nd besides--those Walls, down on the Border don't grow on trees!
"What, Mitch Worry?"
https://thetruthoncommonsense.com
https://thetruthoncommonsense.com
6
Uh oh, you 'forgot' about the repeal of the tax on high income earners which is paid for by the cuts in coverage subsidies for the needy. That is the driver for this whole stupid exercise by the GOP. Nice try, Ross.
10
Doubthat show us a couple of things:
1. That he doesn't understand the nature of affordable insurance, that you need to have many people in the pool who are paying buy not making claims. How can a regular columnist for the prestigious NYT not know that?
2. That the dollars in saving he talks about are loose change compared to the reckless spending on defense and homeland security. And if he really thought about it, he'd realize that better coverage for more people should cost more and that single-payer is the way to do that with the least bureaucratic overhead. Most Americans value health insurance more than a huge arsenal of F-35 raptors.
3. That he has no idea what it is like not to be able to afford health insurance, either for the initial premiums or for sky-high deductibles.
1. That he doesn't understand the nature of affordable insurance, that you need to have many people in the pool who are paying buy not making claims. How can a regular columnist for the prestigious NYT not know that?
2. That the dollars in saving he talks about are loose change compared to the reckless spending on defense and homeland security. And if he really thought about it, he'd realize that better coverage for more people should cost more and that single-payer is the way to do that with the least bureaucratic overhead. Most Americans value health insurance more than a huge arsenal of F-35 raptors.
3. That he has no idea what it is like not to be able to afford health insurance, either for the initial premiums or for sky-high deductibles.
10
if it's a choice between paying taxes and dying... Republicans have clearly shown they prefer death.
especially yours.
especially yours.
14
There are 320 million Americans. Care for them all!
8
Why is it impossible for Ross Douthat to consider fixing Obamacare by considering a public option in order to increase competition in the health care industry by lowering costs and increasing efficiency?
10
Mr. Douthat, you are wrong so often but I treat your words with respect and look forward to reading them.
Today though your column amounts to this :
"Blah, blah, blah-blah-blah. Blah...smart and decent and defensible".
Not your fault, though. Except for your utter failure to recognize the depths of Republican let-them-eat-cake depravity.
This healthcare debate is about one thing: how far can Republicans run from "smart and decent and defensible" and still deny Democrats a whiff of hope.
No one, you or your party, treats this as your own paper does: "For Millions, Life Without Medicaid Services Is No Option".
They're not talking embarrassment at the prescription counter. They're talking, literally, dead people. Caused by you.
All this going on under the rheumy glare of Mad King Trump and the nastiest little bit of hatred and spite to come out of Kentucky...ever.
This debate will go as it will. Given your proclivity to cheat, steal and play the abused political maiden I have little doubt your side will win.
But it is shocking that not one Republican has stood up and recognized that this game you're playing is literally going to kill people. Quite literally.
The only questions coming from the wizened mouth and shriveled soul of the dastard McConnell is how can he hurt even more. How can he take more money from a country that loves to parade around in its moral big boy pajamas and hand it to least the moral, least aware segment of the population - The Rich.
Today though your column amounts to this :
"Blah, blah, blah-blah-blah. Blah...smart and decent and defensible".
Not your fault, though. Except for your utter failure to recognize the depths of Republican let-them-eat-cake depravity.
This healthcare debate is about one thing: how far can Republicans run from "smart and decent and defensible" and still deny Democrats a whiff of hope.
No one, you or your party, treats this as your own paper does: "For Millions, Life Without Medicaid Services Is No Option".
They're not talking embarrassment at the prescription counter. They're talking, literally, dead people. Caused by you.
All this going on under the rheumy glare of Mad King Trump and the nastiest little bit of hatred and spite to come out of Kentucky...ever.
This debate will go as it will. Given your proclivity to cheat, steal and play the abused political maiden I have little doubt your side will win.
But it is shocking that not one Republican has stood up and recognized that this game you're playing is literally going to kill people. Quite literally.
The only questions coming from the wizened mouth and shriveled soul of the dastard McConnell is how can he hurt even more. How can he take more money from a country that loves to parade around in its moral big boy pajamas and hand it to least the moral, least aware segment of the population - The Rich.
9
"...which raises the question of why they’re attempting something so complex for such a modest end."
What is wrong with you, Mr. Douthat? You call taking health insurance away from more than 20 million people a "modest end."
You, sir, are a true Republican. Selfish and heartless. Sick.
What is wrong with you, Mr. Douthat? You call taking health insurance away from more than 20 million people a "modest end."
You, sir, are a true Republican. Selfish and heartless. Sick.
9
Mr. Douthat:
After, yet another, column about solutions bereft of common decency and a total disregard for morality; I'm beginning to think that being a conservative is a pre-existing condition. I don't believe that the country can afford to pay for this
genetic malfeasance much longer.
After, yet another, column about solutions bereft of common decency and a total disregard for morality; I'm beginning to think that being a conservative is a pre-existing condition. I don't believe that the country can afford to pay for this
genetic malfeasance much longer.
14
The mandate is what makes the ACA work. Suggesting its eliminations shows you either don't understand the policy mechanics, or that you are as bad as the GOP pols and simply don't care.
11
Ross, neither your party, and their donors, nor the evil alternative, and their donors, have a clue anymore. And because their cynical, or stupid, or both. And that leaves you, and your colleagues with the dilemma of what or how to fill your weekly allotment of white space. Variations on a theme is like John Wayne's acting principal: don't act, just react.
So, in the final analysis: both parties having skipped passed a viable solution to the health care-system-business-industrial complex these past 100 years have only one pretense to legislating left ( or right ). SINGLE PAYER, MEDICARE FOR ALL. I'm so generous ( stingy, if you prefer ) I'll even include the Koch brothers, Rand Paul, Paul Ryan, McConnell, and all their ilk ( seeings how my taxes, and yours, are paying for them anyway ). Or, let them opt out, do long as they're not allowed to use the emergency room and stick the taxpayers with that mode of fleecing.
So, in the final analysis: both parties having skipped passed a viable solution to the health care-system-business-industrial complex these past 100 years have only one pretense to legislating left ( or right ). SINGLE PAYER, MEDICARE FOR ALL. I'm so generous ( stingy, if you prefer ) I'll even include the Koch brothers, Rand Paul, Paul Ryan, McConnell, and all their ilk ( seeings how my taxes, and yours, are paying for them anyway ). Or, let them opt out, do long as they're not allowed to use the emergency room and stick the taxpayers with that mode of fleecing.
3
"Don’t worry, I have the answer." Yet another Republican solution that allocates pain, suffering, sickness and death differently, perhaps a bit less of it; another case of that euphemism "Medicaid savings." Bravely done, Mr, Douthat. Those people affected are not you and yours, and you hope they are far from the lives and minds of most of your readers, lest they see through the euphemism to the smug moral monster you still are.
7
"not just a crime, but a mistake."
Beautiful synopsis of modern GOP mentality. I don't care if what I do is criminal, all I care about is whether I make gains.
Thank you!
Beautiful synopsis of modern GOP mentality. I don't care if what I do is criminal, all I care about is whether I make gains.
Thank you!
9
In other words, just start chipping away at our "starter" national health care movement so it struggles even more--then come back later claiming it's failing, and mess with it more and more. No, I think we've reached a point of no turning back, and Republicans have helped a majority of Americans, finally, understand the value of government intervention in health care.
7
"That’s it. That’s the whole thing."
Mr. Fix It ignores one thing: innocent people will die.
Mr. Fix It ignores one thing: innocent people will die.
10
Another in a long list of proposals to save the GOP bill by just cutting off half your nose to spite your face.
5
The Republicans have no plan on how to get everyone who needs coverage, which is everybody, an affordable plan. Neither did/do the Democrats. Obamacare does not control medical costs all that much as to make insurance affordable to everyone. Millions cannot afford any Obamacare policy and the out of pocket expenses. Why the Republicans want to own this political stink bomb is beyond me, but hey, Dems cannot wait to hand it to them. No matter what Republicans decide to do even if nothing, they own it now. As kids say in the game of tag - You're it!
1
#BeingHumanIsAPreExistingCondition.
Amazing how you become an expert on healthcare reform, when I suspect you have never worked in the healthcare field.
Do you also know how to get doctors to use computers in their offices? What is your solution for the high cost of drugs? How about the cost of training medical personnel in teaching hospitals?
Surely you can weigh in on some of the real cost factors, that is, beside the administrative expenses of Insurance companies. You are for multiple competing health insurance companies, regardless of mandates, right?
Amazing how you become an expert on healthcare reform, when I suspect you have never worked in the healthcare field.
Do you also know how to get doctors to use computers in their offices? What is your solution for the high cost of drugs? How about the cost of training medical personnel in teaching hospitals?
Surely you can weigh in on some of the real cost factors, that is, beside the administrative expenses of Insurance companies. You are for multiple competing health insurance companies, regardless of mandates, right?
3
Of course, any rational, intelligent person would go big. The evidence is overwhelming that a universal, government run system would deliver better results at much, much lower cost. We already have a system that does just that for the portion of our population that needs the most care--Medicare. Furthermore, there is already a bill that has been introduced in the House every year since 2003--HR676. It currently has 113 cosponsors.
The bill is simple with none of the complexity of the ACA or any of the Republican "reforms" of the ACA. It is only 70 pages long. It just gives an improved version of Medicare to every man, woman, & child in our great nation. One of the improvements is that there are no deductibles, co-pays, or premiums.
An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 Billion per year. The long term savings are in the neighborhood of $1 TRILLION each & every year. This is not a pie in the sky estimate, but is based on decades of experience & data from Medicare & the similar plans of other countries.
This would not be an entirely new program like the ACA. It would be an incremental change in a program we already know how to run, a program that is loved by Americans of ALL political stripes. Remember the Tea Partier's cry of "Keep your filthy gubermint hands offa my Medicare!!"
This is what we should have done in 2009, but we had an administration that was too willing to compromise. We got the ACA.
The bill is simple with none of the complexity of the ACA or any of the Republican "reforms" of the ACA. It is only 70 pages long. It just gives an improved version of Medicare to every man, woman, & child in our great nation. One of the improvements is that there are no deductibles, co-pays, or premiums.
An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 Billion per year. The long term savings are in the neighborhood of $1 TRILLION each & every year. This is not a pie in the sky estimate, but is based on decades of experience & data from Medicare & the similar plans of other countries.
This would not be an entirely new program like the ACA. It would be an incremental change in a program we already know how to run, a program that is loved by Americans of ALL political stripes. Remember the Tea Partier's cry of "Keep your filthy gubermint hands offa my Medicare!!"
This is what we should have done in 2009, but we had an administration that was too willing to compromise. We got the ACA.
4
If the Dems can take the Presidency, the House and Senate...they can pass single payer...that time may be sooner than we think. Post Trump Revolution....
5
"Any plan to solve America's health care mess must confront this reality: Our prices for tests, drugs, hospitalizations and procedures -- old or new -- have gone up dramatically year by year, and are vastly higher than in other developed countries. ... we alone effectively allow businesses -- mostly for-profit -- to set the asking price. ... price and value have in many cases become completely uncoupled, allowing price to travel into the stratosphere.... Though they hold hearings and decry pricing, politicians from both parties have been mostly unwilling or unable to tackle this cost problem head on -- likely because they hear (and benefit) far more from medical industry lobbyists than from patients." - Elisabeth Rosenthal, editor-in-chief of Kaiser Health News, 26 June 2017
4
Full repeal.
Stop. Do nothing else.
That's what the GOP have run, and won, on since '09.
Do it already.
Stop. Do nothing else.
That's what the GOP have run, and won, on since '09.
Do it already.
2
I'll make it simple for you Ross. Single payer, eliminating medical coverage for profit.
11
Medical Bankruptcy is the #1 cause of Going Broke in America.
What do you have for that, Mitch?
Seriously time to strip Congress of taxpayer-funded lifetime healthcare for letting them have a go at shopping around the market themselves.
7
There's nothing 'decent and defensible' about the Republicans currently in power. As you no doubt you realize they are acting on behalf of only one concern: satisfying those donors who've bought them. And as far as they're concerned the rest of us who struggle to pay for health care can just go off and die.
4
Actually, Mr. Doutthat, the solution is a single payer system. It costs far less money than the ridiculous system we have here, with a hodge-podge of for-profit insurance companies messing everything up for everybody, rich and poor.
What's wrong with saving money, as we all would in a single payer system? Jeesh, you conservatives just want to spend, spend, spend, don't you.
What's wrong with saving money, as we all would in a single payer system? Jeesh, you conservatives just want to spend, spend, spend, don't you.
7
Our common goal should clearly be health-care for all; no ifs, ands or buts.
And Mr Douthat offers - what? A 'small-ball' way for the Republicans to retreat while shouting 'ADVANCE!'.
And he is what passes for an 'intellectual' on the right? Good God!
And Mr Douthat offers - what? A 'small-ball' way for the Republicans to retreat while shouting 'ADVANCE!'.
And he is what passes for an 'intellectual' on the right? Good God!
3
Of course, any rational, intelligent person would go big. The evidence is overwhelming that a universal, government run system would deliver better results at much, much lower cost. We already have a system that does just that for the portion of our population that needs the most care--Medicare. Furthermore, there is already a bill that has been introduced in the House every year since 2003--HR676. It currently has 113 cosponsors.
The bill is simple with none of the complexity of the ACA or any of the Republican "reforms" of the ACA. It is only 70 pages long. It just gives an improved version of Medicare to every man, woman, & child in our great nation. One of the improvements is that there are no deductibles, co-pays, or premiums.
An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 Billion per year. The long term savings are in the neighborhood of $1 TRILLION each & every year. This is not a pie in the sky estimate, but is based on decades of experience & data from Medicare & the similar plans of other countries.
This would not be an entirely new program like the ACA. It would be an incremental change in a program we already know how to run, a program that is loved by Americans of ALL political stripes. Remember the Tea Partier's cry of "Keep your filthy gubermint hands offa my Medicare!!"
This is what we should have done in 2009, but we had an administration that was too willing to compromise. We got the ACA.
The bill is simple with none of the complexity of the ACA or any of the Republican "reforms" of the ACA. It is only 70 pages long. It just gives an improved version of Medicare to every man, woman, & child in our great nation. One of the improvements is that there are no deductibles, co-pays, or premiums.
An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 Billion per year. The long term savings are in the neighborhood of $1 TRILLION each & every year. This is not a pie in the sky estimate, but is based on decades of experience & data from Medicare & the similar plans of other countries.
This would not be an entirely new program like the ACA. It would be an incremental change in a program we already know how to run, a program that is loved by Americans of ALL political stripes. Remember the Tea Partier's cry of "Keep your filthy gubermint hands offa my Medicare!!"
This is what we should have done in 2009, but we had an administration that was too willing to compromise. We got the ACA.
2
As usual a Republican who refuses to deal with facts.
What are these people, who "voluntarily" drop health coverage, going to do when they INEVITABLY get sick or injured? We've tried this before. Just go look at the data pre-ACA. It's bad, very bad. The low estimate (which can be found in this very newspaper) are 40,000 dead. But at least they'll have #freedom.
Where are the elderly in nursing homes going to go when their state slashes medicaid? Republicans seems to forget that the majority of medicaid spending goes to pay for nursing home care for the elderly (not "those" people as Fox would have you believe).
To whom are the disabled going to turn when states drop them from medicaid? Republicans seems to forget that even with the ACA simply being disabled in 'Merica is almost a sure path to grinding poverty. How is booting them off the Medicaid rolls going to help again? Oh that's right it doesn't.
Sad.
What are these people, who "voluntarily" drop health coverage, going to do when they INEVITABLY get sick or injured? We've tried this before. Just go look at the data pre-ACA. It's bad, very bad. The low estimate (which can be found in this very newspaper) are 40,000 dead. But at least they'll have #freedom.
Where are the elderly in nursing homes going to go when their state slashes medicaid? Republicans seems to forget that the majority of medicaid spending goes to pay for nursing home care for the elderly (not "those" people as Fox would have you believe).
To whom are the disabled going to turn when states drop them from medicaid? Republicans seems to forget that even with the ACA simply being disabled in 'Merica is almost a sure path to grinding poverty. How is booting them off the Medicaid rolls going to help again? Oh that's right it doesn't.
Sad.
7
Once again someone who either doesn't understand the very concept of insurance, or chooses to ignore it, holds forth with ' end the mandate'.
All insurance is is a sharing of a risk which is there for everyone. Some will need help sooner, some later, so if the group mixes both sets of people the premiums of the 'laters' act to offset the losses of the 'sooners'.
As to ' continuous coverage' being a guarantee of anything, all it would do is guarantee an increase in uninsured people going to emergency rooms after they are very sick.
Unless you plan to not treat them in the interim.
It is said that there's nothing like a true Christian, and this thinking shows you too are nothing like one.
All insurance is is a sharing of a risk which is there for everyone. Some will need help sooner, some later, so if the group mixes both sets of people the premiums of the 'laters' act to offset the losses of the 'sooners'.
As to ' continuous coverage' being a guarantee of anything, all it would do is guarantee an increase in uninsured people going to emergency rooms after they are very sick.
Unless you plan to not treat them in the interim.
It is said that there's nothing like a true Christian, and this thinking shows you too are nothing like one.
6
Ross Douthat wake up! The ACA was the CONSERVATIVE health care plan that worked in Massachusetts, Romney care. Stop trying to disown this plan.
5
Maybe the Republicans should repeal Obamacare and replace it with the Affordable Coverage Act.
2
Small men, small ideas. BIG legislation for rich people.
4
No mention of the huge tax savings for wealthy Americans???? That is the bottom line.
3
Keep h/c spending small? Keep govt small, keep democracy small, for we the people. Let Americans sicken and die slowly, and our influence on our govt weaken, while the super rich see their untaxed wealth and political input compound.
This column is confused, and overly complicated, just like US health care.
The Times can well defend itself against charges of being a ‘liberal media paper’ with trusty conservative columnists like Douthat, Stephenson, Brooks etc.
The various plans working abroad for generations are still not explained in our media and the Times. It's the heart of the biggest issue of our time, yet even the liberal columnists avoid it. They get much more mileage from just lambasting Trump and Gop, then in an evidenced based discussion about what works, with data from all over the world.
Times columnists neglect the press's role to inform the public in a democracy, and for this they get prestige, a megaphone, and excellent health insurance with the Times that they can well afford on their nice salaries. Then they lecture us to be satisfied with the 3rd rate, that millions of citizen abroad would never put up with.
This column is confused, and overly complicated, just like US health care.
The Times can well defend itself against charges of being a ‘liberal media paper’ with trusty conservative columnists like Douthat, Stephenson, Brooks etc.
The various plans working abroad for generations are still not explained in our media and the Times. It's the heart of the biggest issue of our time, yet even the liberal columnists avoid it. They get much more mileage from just lambasting Trump and Gop, then in an evidenced based discussion about what works, with data from all over the world.
Times columnists neglect the press's role to inform the public in a democracy, and for this they get prestige, a megaphone, and excellent health insurance with the Times that they can well afford on their nice salaries. Then they lecture us to be satisfied with the 3rd rate, that millions of citizen abroad would never put up with.
2
Sorry Ross but couldn't get passed that "the Democratic bill in 2010 delivered significantly to the party's base". So millions of people getting health insurance for the first time particularly in poor red states was for the Democratic base. In the immortal words of Bob Dole - whatever
4
As I understand it, the biggest problem with health insurance 8 years ago was that seven percent of people had to purchase their own insurance and it was unaffordable. In addition, cost for healthcare were spiraling out of control. This plan, the GOP plan, and the ACA do NOTHING to stop the spiraling out of control. They all harm someone with the GOP taking the biggest bite into Americans while benefiting a select, well financed few. The GOP plan and this plan still love to punish those who lapse in coverage. Why? What happens if someone loses their healthcare and has to choose between food on the table and health insurance.? Guess what goes? Our response - punish them.
And what of cost? NONE of the plans seeks to lower the cost of health insurance. This waterdowned GOP Plan, as well as, Trumpcare seek to lower the federal budget not the cost of healthcare. This proposal as does the GOP plan takes healthcare away from our most vulnerable, but, ah heck, so what if people die or go bankrupt because of illness. What is the measure of a society that doesn't care about its most vulnerable - children, elderly, disabled, poor, and women?
And what of cost? NONE of the plans seeks to lower the cost of health insurance. This waterdowned GOP Plan, as well as, Trumpcare seek to lower the federal budget not the cost of healthcare. This proposal as does the GOP plan takes healthcare away from our most vulnerable, but, ah heck, so what if people die or go bankrupt because of illness. What is the measure of a society that doesn't care about its most vulnerable - children, elderly, disabled, poor, and women?
In effect what Ross Douthat is suggesting to Republicans is don't be too cruel and you'll get to keep your jobs. Don't do a wholesale slaughter of healthcare. Just kill a few people at a time, hide the bodies and no one will notice.
And you don't have to give the rich all the tax breaks with healthcare, you can give them more money with your "tax reform".
That's detestable.
And you don't have to give the rich all the tax breaks with healthcare, you can give them more money with your "tax reform".
That's detestable.
5
What this country needs is a special bronze plan for congressional republicans. Bronze them and set them up in a new memorial space to be named the Ronald Reagan Hall of the Last Republicans.
2
The Democratic achievement was in large part a sellout to insurance/pharma and a relatively meager accomplishment.
The Republican position, as it is on all things, is far far worse worse as well as dishonestly presented.
Inspiring.
The Republican position, as it is on all things, is far far worse worse as well as dishonestly presented.
Inspiring.
3
Ross, I am starting to think that you are completely out of touch with current members of the GOP. When you were not looking, the Social Darwinists and the Malthusians seized control.
On healthcare, as on so much else, the majority of Republicans embrace the brutal economic fatalism of Rev. Thomas R. Malthus:
"To act consistently [in accord with the laws of population increase, of scarcity and of the market], we should facilitate, instead of foolishly and vainly . . . impede, the operation of nature in producing . . . mortality . . . ." An Essay on the Principle of Population (New York: Dutton, 1960), vol. 2, pp. 179-80; originally published in 1803.
Further guidance from a more recent "conservative" economist:
For ethics and religion, "the question of whether a drug is wanted by a doctor to cure a patient or by a murderer to kill his family is a very serious matter, but from [the point of view of minimally regulated capitalism], it is totally irrelevant. . . . [T]he drug is useful [for turning a profit] in both cases, and may be more so in the latter case than in the former." Leon Walras, Principles of Economics and Sociology, (Urbana, U. of Illinois Press, 1963), p. 65.
The GOP faithfully advocates old-time robber baron, Gilded Age capitalism.
Ayn-Randian healthcare provides the underclasses with a great cure for all of life's ills. It culls the human heard. It eliminates the need for death panels by simply clearing the way for natural & market-place inevitabilities.
On healthcare, as on so much else, the majority of Republicans embrace the brutal economic fatalism of Rev. Thomas R. Malthus:
"To act consistently [in accord with the laws of population increase, of scarcity and of the market], we should facilitate, instead of foolishly and vainly . . . impede, the operation of nature in producing . . . mortality . . . ." An Essay on the Principle of Population (New York: Dutton, 1960), vol. 2, pp. 179-80; originally published in 1803.
Further guidance from a more recent "conservative" economist:
For ethics and religion, "the question of whether a drug is wanted by a doctor to cure a patient or by a murderer to kill his family is a very serious matter, but from [the point of view of minimally regulated capitalism], it is totally irrelevant. . . . [T]he drug is useful [for turning a profit] in both cases, and may be more so in the latter case than in the former." Leon Walras, Principles of Economics and Sociology, (Urbana, U. of Illinois Press, 1963), p. 65.
The GOP faithfully advocates old-time robber baron, Gilded Age capitalism.
Ayn-Randian healthcare provides the underclasses with a great cure for all of life's ills. It culls the human heard. It eliminates the need for death panels by simply clearing the way for natural & market-place inevitabilities.
2
Pray 1) Why don't we look to Germany for their system 2) In a letter to the editor a week or two ago it disclosed in this proposed law major funds would be withdrawn from Medicare....... is that correct? That is the hidden elephant in the room. I do not recall this nentioned
3) A diabetic doctor wrote about the extraordinary increase in insulin 4) Do you believe all diabetics are fat people mostly immigrants who eat fast food? Why in the world are drugs so expensive that were cheaper before ? Yes there are plenty of people eating the wrong food but that is not the issue. Diabetics need proper behavior but need life saving meds. As do othersb.5) i think worst than death is an unnecessary death or suffering. 6) Lets go to taxes. Why is the cost of interest even in moderate use of credit cards and with a top credit score often 15 percent not deductible. Yet banks are paying minimum rate based on Fed rate. i know I know interest charged is by State.
7) why preach to the choir. There is abuse and high profitability to many and no one cares in the least I am sorry to say most of the elite of the Times
8) Last night i took just some flowers to my neighbor 50s hugged her and she cried; all I could say was I know I know. Battling cancer 2 yrs that recurred fr breast now in her brain and with a daughter mentally fine but physically incapacitated her fear is if the insurance will cover it. If she will survive the economic impact of loss of income
Be mindful.
3) A diabetic doctor wrote about the extraordinary increase in insulin 4) Do you believe all diabetics are fat people mostly immigrants who eat fast food? Why in the world are drugs so expensive that were cheaper before ? Yes there are plenty of people eating the wrong food but that is not the issue. Diabetics need proper behavior but need life saving meds. As do othersb.5) i think worst than death is an unnecessary death or suffering. 6) Lets go to taxes. Why is the cost of interest even in moderate use of credit cards and with a top credit score often 15 percent not deductible. Yet banks are paying minimum rate based on Fed rate. i know I know interest charged is by State.
7) why preach to the choir. There is abuse and high profitability to many and no one cares in the least I am sorry to say most of the elite of the Times
8) Last night i took just some flowers to my neighbor 50s hugged her and she cried; all I could say was I know I know. Battling cancer 2 yrs that recurred fr breast now in her brain and with a daughter mentally fine but physically incapacitated her fear is if the insurance will cover it. If she will survive the economic impact of loss of income
Be mindful.
4
You know how the GOP could wipe out the Democrats out once and for all?
Repeal Obamacare and allow everybody not covered by an employer to buy into Medicare.
If they did that, I'd actually consider voting for a Republican someday.
Repeal Obamacare and allow everybody not covered by an employer to buy into Medicare.
If they did that, I'd actually consider voting for a Republican someday.
What's that line about lipstick on a pig? Goodness, Ross!
Did you really write that the people who lose their health insurance didn't want it anyway? Right now, my car, my house, and my health all seem pretty good ( knock wood). I don't want to pay for the insurance I have on any of those things either, right now. But what always happens to the brave, freedom loving, insurance hating libertarians is that they suddenly get sick, and it's too expensive to buy the medical care that insurance would cover. But we, the American taxpayers, have to cover them anyway because it's too cruel to turn a sick person away. And it costs us way more money than if they just bought insurance like the rest of us.
The notion that if you let your insurance lapse you have to pay little more or go without a little longer when you need it is just plain stupid. Are you seriously suggesting that someone with lapsed insurance and a broken leg, a growing tumor, or an open wound just wait a few more weeks until the penalty period ends? Or, do they have to pay extra to get their insurance turned on right away? I'm sure they've been saving up just in case, you know, as insurance.
Did you really write that the people who lose their health insurance didn't want it anyway? Right now, my car, my house, and my health all seem pretty good ( knock wood). I don't want to pay for the insurance I have on any of those things either, right now. But what always happens to the brave, freedom loving, insurance hating libertarians is that they suddenly get sick, and it's too expensive to buy the medical care that insurance would cover. But we, the American taxpayers, have to cover them anyway because it's too cruel to turn a sick person away. And it costs us way more money than if they just bought insurance like the rest of us.
The notion that if you let your insurance lapse you have to pay little more or go without a little longer when you need it is just plain stupid. Are you seriously suggesting that someone with lapsed insurance and a broken leg, a growing tumor, or an open wound just wait a few more weeks until the penalty period ends? Or, do they have to pay extra to get their insurance turned on right away? I'm sure they've been saving up just in case, you know, as insurance.
4
It makes me laugh to read or hear conservatives discuss America's healthcare. They're so deep into taxes and markets and choice, all cloaked in freedom. What seems to be missing from their discussion of healthcare is health itself. It makes columns such as this one bizarre...absurd...surreal. Funny! Until you think about it a bit.
The object should be to make healthcare available to all our people, even to our guests, invited and uninvited. No one should be required to beg. No one should be shuttled from ER to ER. No provider stuck with a bill. Rural healthcare supported. Men and women, old and young, healthy and ill, even the "unborn" through prenatal care, all should be able to get needed care.
If healthcare didn't cost a nickel, Republicans wouldn't mind everyone having it. But even in nations that manage it far better than we do, it's expensive. So we get wonky columns that put healthcare in terms like "voluntary drop-off" and "limited cuts" rather than "expanded" and "easier" and "more cost effective".
Or how about the term, "national security"?
The military has listed the health of our people a high priority. When will the GOP do likewise?
The object should be to make healthcare available to all our people, even to our guests, invited and uninvited. No one should be required to beg. No one should be shuttled from ER to ER. No provider stuck with a bill. Rural healthcare supported. Men and women, old and young, healthy and ill, even the "unborn" through prenatal care, all should be able to get needed care.
If healthcare didn't cost a nickel, Republicans wouldn't mind everyone having it. But even in nations that manage it far better than we do, it's expensive. So we get wonky columns that put healthcare in terms like "voluntary drop-off" and "limited cuts" rather than "expanded" and "easier" and "more cost effective".
Or how about the term, "national security"?
The military has listed the health of our people a high priority. When will the GOP do likewise?
7
The problem I have with all the GOP health plans is they are geared to get the GOP reelect, to make the base happy and to make their big money people happy. They are not geared to help the American people. Say what you want about Obamacare but it was geared to help the American people. This is proven by how they are measured. Obamacare is measured by how many people now have insurance, Trumpcare is measured by how many people it takes insurance away from.
3
It is Ok that They done retreat. Within two or three election cycles there'll have killed off about 20-30% if their base. Sad for them, but so goes the path of Republican Death Panels.
1
Yeah, Ross, in your dreams. The cuts in the programs, taxes and requirements will make the GOP into heroes, until the bodies start to pile up. The -nicest- thing that will happen is that ERs - particularly in red states - will again overflow with those who are incapable of paying, but who are required by law to be treated. When hospitals go bankrupt or tax money must be used to keep them open ... real smart, those GOP!
3
That might have worked six months ago. But now it's got the stink of avarice all over it.
Bottom line without sufficient funding to subsidize care for the sick and poor there isn't insurance for the sick and poor, the free markets never operate against their economic interests, that's called capitalism. And the sick and poor uninsured end up costing society more over time, Emergency visits, unemployment, incarceration and so on. Ross why can't you and the Republicans simply acknowledge reality? I guess you could repeal EMTALA at the same time so the sick and poor die in the streets.
1
"smart and decent and defensible"
Can this be said about ANY republican legislative efforts?!
Read the nytimes article referring to Pruitt's success gutting sound EPA regs. and look at this abysmal attempt at health care reform and honestly tell me what is smart and decent and defensible about any of this.
Can this be said about ANY republican legislative efforts?!
Read the nytimes article referring to Pruitt's success gutting sound EPA regs. and look at this abysmal attempt at health care reform and honestly tell me what is smart and decent and defensible about any of this.
4
Good article and very reasonable proposal. The key is that the Republicans must do something! They have majorities in the House, Senate and their party is in the White House. When the democrats had this in 2010, Rahm Emmanuel pulled out all his tricks, Jonathan Gruber took advantage of the stupidity of the American voters, and the democrats created a massive new entitlement program. The Republicans simply have to prove they can get something done now that they control the levers of power.
This is a watershed moment for our nation. It is the first real attempt to roll back a massive entitlement program. Let us hope the Republicans can pull it off!
This is a watershed moment for our nation. It is the first real attempt to roll back a massive entitlement program. Let us hope the Republicans can pull it off!
1
Ross, how about informing the readers that the ACA was actually a Right Wing Republican Think Tank Creation to begin with, coming from the Heritage Foundation. It was later made into RomneyCare, complete with Mandate, which was included as a required part in the original.
In the House there were more than twice as many Repub amendments to the bill, many of them of the 'poison pill type', like allowing States to opt out and the like, and more than twice as many Repub over Dem amendments were accepted to the final bill.
This was a Republican Plan all along, and pinning it solely on Obama has been disingenious from the beginning. Cutting it now means that some 22 million people will lose their insurance coverage and a percentage of those people WILL Die because of the lack of medical care.
Is that the intent of this bill: To Kill American Citizens?
If it is, and it seriously looks that way since where the money saved is going to tax breaks for those who do not need them at all, and it is NOT going to the defecit which the Republicans have screamed about for the last 8 years.
The depth of deceit and treachery within the Republican Party has fully reached the stage of Visible Racketeering and Influencing of Corrupt Officials in both Senate and House, is evident in the President and his cabinet picks and in the Repub members of the Supreme Court: all three are fully complicit in allowing corporations to dictate through the Govt.
That is the real definition of a Fascist State
In the House there were more than twice as many Repub amendments to the bill, many of them of the 'poison pill type', like allowing States to opt out and the like, and more than twice as many Repub over Dem amendments were accepted to the final bill.
This was a Republican Plan all along, and pinning it solely on Obama has been disingenious from the beginning. Cutting it now means that some 22 million people will lose their insurance coverage and a percentage of those people WILL Die because of the lack of medical care.
Is that the intent of this bill: To Kill American Citizens?
If it is, and it seriously looks that way since where the money saved is going to tax breaks for those who do not need them at all, and it is NOT going to the defecit which the Republicans have screamed about for the last 8 years.
The depth of deceit and treachery within the Republican Party has fully reached the stage of Visible Racketeering and Influencing of Corrupt Officials in both Senate and House, is evident in the President and his cabinet picks and in the Repub members of the Supreme Court: all three are fully complicit in allowing corporations to dictate through the Govt.
That is the real definition of a Fascist State
5
"tepid and incrementalist" is almost always the best option, to anything.
Mr Douthat is just writing for writing's sake here. He knows any changes to the ACA will be even more minor than what he proposes. Why? Because Republicans have had ample opportunity to put into law the health care plan created by the Heritage Foundation and promoted by Nixon in 1973. The same one conservative leaders such as Newt Gingrich were still pushing 30 years later.
But then the unthinkable happened. A Democrat with the political capital said "OK, let's do it. But let's make it a little more conservative than what Nixon wanted." And that socialist abomination, the Affordable Care Act, was born.
Similar to Cap-and-Trade - the free market alternative to draconian air pollution penalties - which was invented by conservative capitalists. It existed with some success until applied to CO2 emissions at which point it became an idiotic concept that was even worse than taxation.
The lesson here is that for Republicans, any idea, plan, or policy and how it hurts or helps actual humans living in the U.S. is utterly irrelevant. If it is adopted by the Right, it is canonical common sense and must become law. But if a Democrat, especially one that's "clearly not one of us", decides to be the first to make it happen, then it becomes a great evil that always was and always shall be one of the greatest threats to America we have ever seen.
For Republicans, the only thing that matters is winning a fight. Just ask the guy they nominated for president last year.
But then the unthinkable happened. A Democrat with the political capital said "OK, let's do it. But let's make it a little more conservative than what Nixon wanted." And that socialist abomination, the Affordable Care Act, was born.
Similar to Cap-and-Trade - the free market alternative to draconian air pollution penalties - which was invented by conservative capitalists. It existed with some success until applied to CO2 emissions at which point it became an idiotic concept that was even worse than taxation.
The lesson here is that for Republicans, any idea, plan, or policy and how it hurts or helps actual humans living in the U.S. is utterly irrelevant. If it is adopted by the Right, it is canonical common sense and must become law. But if a Democrat, especially one that's "clearly not one of us", decides to be the first to make it happen, then it becomes a great evil that always was and always shall be one of the greatest threats to America we have ever seen.
For Republicans, the only thing that matters is winning a fight. Just ask the guy they nominated for president last year.
7
More silly ideas about health care. Why doesn’t Ross suggest fixing the ACA instead of regurgitating Republican bad ideas.
By the way, the eliminating the mandate, and replacing it with a continuous coverage requirement would not work at all. Folks who cannot afford the premiums now would lapse their health policies - and the solution would be…. to prevent them from buying insurance for an additional period. Wow! How does that work in the real world.
If we did this with auto insurance, where many also have a problem paying for coverage, what would happen is that over time, fewer folks would have auto insurance, and the next time you had an auto accident, the likelihood is that one of you would not be insured.
Time for the NY Times in interview folks who are inside the health insurance business and see what might work. Guessing is not that answer.
By the way, the eliminating the mandate, and replacing it with a continuous coverage requirement would not work at all. Folks who cannot afford the premiums now would lapse their health policies - and the solution would be…. to prevent them from buying insurance for an additional period. Wow! How does that work in the real world.
If we did this with auto insurance, where many also have a problem paying for coverage, what would happen is that over time, fewer folks would have auto insurance, and the next time you had an auto accident, the likelihood is that one of you would not be insured.
Time for the NY Times in interview folks who are inside the health insurance business and see what might work. Guessing is not that answer.
3
Is Mr. Douthat serious in encouraging the GOP to adopt his "timid" approach - as a better alternative to the current Senate abomination ?
Mr. Douthat: give us your ideal version of what the Americam health care system should look like.
Then defend it against the model that is daily gaining greater momentum amongst NYT readers: a Medicare for all basic safety net and limiting the competitive insurance market to the sale of supplemental insurance.
Mr. Douthat: give us your ideal version of what the Americam health care system should look like.
Then defend it against the model that is daily gaining greater momentum amongst NYT readers: a Medicare for all basic safety net and limiting the competitive insurance market to the sale of supplemental insurance.
6
In the end of all this, what we need is health care universally available through Medicaid as a baseline, with all kinds of glitzy packages for the plutocrats to purchase.
1
Politically feasible and downright just kicking the can on to a near certain, near future health care catastrophe are two wildly different labels for the same disastrous consequence.
1
Ross.... this is a good first step. But I think your idea of no mandate might make the whole thing explode. But some of your other ideas are not bad.
Now do you have any ideas on lowering deductibles or premiums? That seems to be what people are screaming about.
Now do you have any ideas on lowering deductibles or premiums? That seems to be what people are screaming about.
One problem. It is not a health care bill. It is a tax cut bill. The rest is commentary.
7
If you repeal the individual mandate, will you then serve on the death panel that will deny medical care to those who lack both insurance and the financial resources to pay for needed care? Or will those of us who pay for insurance be mandated to pay more to cover the unreimbursed costs of treating those who chose not to pay for insurance when they get in over their heads?
2
For Douthat's proposed changes to be beneficial for our country, we have to give the benefit of the doubt to Republicans in State legislatures and in Governor's mansions who have spent the past seven years, like Republicans in Congress, doing everything they can to thwart any and all possible success of the ACA. Everything they have done since the ACA became law says they do NOT deserve any benefit of the doubt at all.
What have Republicans done to DESERVE being given the benefit of the doubt about any healthcare or insurance law?
Republicans in Congress reversed an Obama ATF policy against selling firearms to mentally ill people surviving on SSI disability. They passed a law to make it legal to sell firearms to paranoid schizophreniacs. That's ALL they have done in the past 7 years to help people who are not well off. Douthat thinks we should trust them to do as much good(?) once again.
What have Republicans done to DESERVE being given the benefit of the doubt about any healthcare or insurance law?
Republicans in Congress reversed an Obama ATF policy against selling firearms to mentally ill people surviving on SSI disability. They passed a law to make it legal to sell firearms to paranoid schizophreniacs. That's ALL they have done in the past 7 years to help people who are not well off. Douthat thinks we should trust them to do as much good(?) once again.
3
I just love how people with stable jobs and health insurance dream up "Modest Proposal" plans for the rest of us. Your plan, in your mind an exercise in fiscal restraint, is just cruelty light compared to the garbage Congressional GOPers are pushing. Entitlement reform of $250B? Those numbers represent peoples' lives. Sure some people would lose coverage? Again, the lives of humans.
I will never understand how some Christians can put worshipping a market god ahead of their moral and religious duty.
I will never understand how some Christians can put worshipping a market god ahead of their moral and religious duty.
78
Mr. Douthat discusses, here, as he must, the political implications of health care legislation. At some point, though, we ought to simply look at what's right, shouldn't we? As a Democrat I may be frustrated at being on the outs electorally. But it's a small price to pay for saving lives, isn't it? This article is yet another comical thought-experiment in how to apply still more chewing gum, paper clips, and baling wire to the pathetic and barbaric jalopy of free market health care (in the interests of winning the next election), before we come to our senses, just scrap the heap, and get back on the road with single payer. We will, eventually. But I suppose we have to go through this in the meantime. Sigh.
2
The answer is much simpler than Ross's suggestions. We can let Medicare become the "health care for all" or join the Congressional insurance program that our Senators and Congressmen enjoy.
Why re-invent the wheel?
Why re-invent the wheel?
3
The "hated mandate" is what makes insurance (of any kind!) work. I couldn't get a mortgage without full insurance. I can't drive without insurance. If only sick people get insurance it doesn't work. Uninsured people head to the emergency rooms when ill, and we all pay. What on earth is unclear about that? We pay MORE without the mandate. Get real. It's only "hated" because the right wing says it is endlessly.
6
How can Douthat uphold market solutions while ignoring them ? He continues to echo the GOP knee-jerk disdain for mandated health insurance. He says of the senate bill:
"It would replace [the mandate], as the Senate bill does, with a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months."
Can he be serious ? Sometimes abstract incentive theory just makes no sense. All the 'continuous coverage requirement' would do is dump millions of poor uninsured, young & foolish, addicted and chronically ill folks into emergency rooms. We mandate free care for acute illness.
No one expects to get sick so there is a huge incentive to buy a new phone before shelling out any premium at all. When folks are well- they try not to worry.
Health insurance is not like a new phone or TV. It is not a commodity that you should choose to 'buy' - and the rich should get more, the poor less. Just as we mandate auto & homeowners insurance, the essential feature of insurance solvency is a large risk pool of folks who never use it !
Moreover- instead of citing humanitarian motives, we should alert the GOP that untreated TB in restaurant workers, diabetic cognitive changes in an untreated bus driver, untreated psychotic illness in the streets, children with early problems (that grow more costly as adults) are bad for everyone.
Be selfish! Embrace a national health insurance. The rich can buy concierge care.
"It would replace [the mandate], as the Senate bill does, with a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months."
Can he be serious ? Sometimes abstract incentive theory just makes no sense. All the 'continuous coverage requirement' would do is dump millions of poor uninsured, young & foolish, addicted and chronically ill folks into emergency rooms. We mandate free care for acute illness.
No one expects to get sick so there is a huge incentive to buy a new phone before shelling out any premium at all. When folks are well- they try not to worry.
Health insurance is not like a new phone or TV. It is not a commodity that you should choose to 'buy' - and the rich should get more, the poor less. Just as we mandate auto & homeowners insurance, the essential feature of insurance solvency is a large risk pool of folks who never use it !
Moreover- instead of citing humanitarian motives, we should alert the GOP that untreated TB in restaurant workers, diabetic cognitive changes in an untreated bus driver, untreated psychotic illness in the streets, children with early problems (that grow more costly as adults) are bad for everyone.
Be selfish! Embrace a national health insurance. The rich can buy concierge care.
2
The conservative preoccupation with the continuous coverage requirement is infuriating. It exemplifies the conservative conception of citizens as criminals the government needs to be protected from. Does Douthat not know that the person most in need of healthcare assistance is the family breadwinner who has just lost his job and is temporarily unable to afford insurance? Is he unaware that this person may be forced to choose between an insurance payment, a mortgage payment, or pillaging his retirement funds? Does he know that it often takes more than two months to find a job?
I have never been more angry that I am now at conservatives who see healthcare as a financial transaction and patients in need as "consumers." Republicans are the worst enemy of the average American. We'll all be better off when they are gone. I am filled with anger and disgust.
I have never been more angry that I am now at conservatives who see healthcare as a financial transaction and patients in need as "consumers." Republicans are the worst enemy of the average American. We'll all be better off when they are gone. I am filled with anger and disgust.
4
Mr. Douthat implies that the ACA was a democratic initiative, while the truth is quite different. The Obama bill was largely crafted on the one in Mass. that then governor Romney signed into law. It was also crafted around suggestions & ideas emanating from the AEI, no friend of democrats. Beyond these points, presidents of both parties, for many years, had tried (and failed) to pass similar legislation. But my main point is this: without an individual mandate, who pays for your coverage when you break a leg, have an MI, get a cancer diagnosis? 'We the people' do. Are we allowed to drive a vehicle without insurance? No. When I break my leg, and go to the ER, who pays for it? Look in the mirror: You do. Obamacare simply codified a long-standing Republican stated value of individual responsibility. The fact that Republicans decry it now is beyond ironic, into hyper-hypocritical.
2
After basically saying nothing that would promote "better" healthcare for United States citizens, Tom Price, our doctor Secretary of State, was asked a question about his boss, Donald Trump, by Chuck Todd this morning.
The question, two fold. One that Donald Trump did not speak up to the healthcare benefit issue, and two, what was Price's opinion of Trump's tweets.
Price dodged anything about tweets and actually demeaned Todd for bringing it up!
Price said the country essentially needs to move forward in regards to healthcare and benefits. Exactly! This woman, nurse of many years, healthcare provider to diverse populous and demographics would love to see Trump spend time and energy to at least be interested in the country's healthcare needs.
We don't care about the private conversations and discussions in supposed Oval Office meetings with Donald Trump. We want to see open, public hearings with agencies speaking to healthcare needs, the ANA, AHA, AMA, and others. We want transparencies to know what is being told to Trump and Congress, if anything if they truly have been invited to the table.
We don't want a president who cannot stop his stupid, childish tweeting. We want a president and a Congress who care about the innards of healthcare in relationship to the needs of the American people. Republicans are probably not the only ones who voted for Trump. I would bet there are others who voted for Trump because they do/did want an insurance improvement.
Do your jobs!
The question, two fold. One that Donald Trump did not speak up to the healthcare benefit issue, and two, what was Price's opinion of Trump's tweets.
Price dodged anything about tweets and actually demeaned Todd for bringing it up!
Price said the country essentially needs to move forward in regards to healthcare and benefits. Exactly! This woman, nurse of many years, healthcare provider to diverse populous and demographics would love to see Trump spend time and energy to at least be interested in the country's healthcare needs.
We don't care about the private conversations and discussions in supposed Oval Office meetings with Donald Trump. We want to see open, public hearings with agencies speaking to healthcare needs, the ANA, AHA, AMA, and others. We want transparencies to know what is being told to Trump and Congress, if anything if they truly have been invited to the table.
We don't want a president who cannot stop his stupid, childish tweeting. We want a president and a Congress who care about the innards of healthcare in relationship to the needs of the American people. Republicans are probably not the only ones who voted for Trump. I would bet there are others who voted for Trump because they do/did want an insurance improvement.
Do your jobs!
33
Whoops, make that Secretary of Health and Human Services.
Sorry!
Sorry!
Politicians and pundits too often treat the number of uninsured Americans among competing plans like the score in a baseball game. Tote up the number covered, the winners and losers, budget implications, and declare a winner. Move on to the next game ("Tax Reform!").
Sorry Ross, this is not a game, it's real-life and you do not get to say "That’s it. That’s the whole thing" until you answer one more question:
What are the detailed rules for providing non elective medical care to people (including children) without coverage (through choice or circumstance) and without the ability to pay?
What do you propose Ross? Let them die and mandate that the States pick up the cost of burial or is that too "libertarian"? Provide emergency treatment but allow reduction in standards of care? Different rules for kids? Let providers shift all costs to ... insurance companies, tax payers, both? Who audits the cost shifting?
You don't have a plan until you honestly answer how you intend to treat the uninsured. And don't forget to add up that cost when determining which plan "wins".
Sorry Ross, this is not a game, it's real-life and you do not get to say "That’s it. That’s the whole thing" until you answer one more question:
What are the detailed rules for providing non elective medical care to people (including children) without coverage (through choice or circumstance) and without the ability to pay?
What do you propose Ross? Let them die and mandate that the States pick up the cost of burial or is that too "libertarian"? Provide emergency treatment but allow reduction in standards of care? Different rules for kids? Let providers shift all costs to ... insurance companies, tax payers, both? Who audits the cost shifting?
You don't have a plan until you honestly answer how you intend to treat the uninsured. And don't forget to add up that cost when determining which plan "wins".
45
Once again demonstrating that the problems with Conservative Theory are systemic; the math is bad and the assumptions about human behavior are just plain old weird.
Nevertheless, Ross, I enjoy reading your essays. Keep it up.
Nevertheless, Ross, I enjoy reading your essays. Keep it up.
Just another pathetic proposal crippling the ACA and doing absolutely NOTHING about the high price of healthcare in this country. We must get Profit (and politicians) out of Healthcare! Every other major country has figured this out with lower costs and better outcomes.
2
Capping Medicaid would be like capping the amount of water a fire department is allowed to use. Or the amount of ammunition an army could use. When you reach your limit on any of those three, people will die.
3
I haven't read all 213 comments, so pardon me if this is redundant, but why? Why repeal the mandate? If we require car insurance, why not health insurance? And, why repeal the taxes? Who pays them other than those who can afford them? And why roll back Medicaid support, even if less than the Repubs? What is achieved by that other than savings for something else?
Ross, I don't understand your point.
Ross, I don't understand your point.
1
But the whole point for the Republicans of repealing Obamacare is the tax cut for the rich. That's why Republican donors hated Obamacare, not the mandates (a Republican idea). The story about repealing mandates for the sake of freedom is a classic cover story--also called propaganda-- for the tax cut.
Mr Douthat's modest proposal misses the whole point.
Mr Douthat's modest proposal misses the whole point.
2
Mr. Douthat, until your party embraces health care as a right, as opposed to a privilege that is bought and sold on some kind of an open market (in theory), then little in terms of solutions will come to pass between the political parties.
For example, you talk of the individual mandate as a principled anathema to the GOP (even though the concept came out of your think tanks), but removal of the mandate has been tried in Washington in the mid 1990s and this lead to a collapse of the local insurance market.
http://www.seattletimes.com/seattle-news/why-washington-states-health-re...
Washington did attempt to implement their own version of the ACA in the mid 1990s and then, like now, the debate is not centered around the delivery of health care from your end, but the commodization of it and that mentality lead to the collapse of the market.
Even your suggestion of a waiting period to try and maintain something stable puts the onus of risk upon those who are purchasing plans. Your suggestion regarding savings on dropped taxes is again a canard because it could just as easily become a higher profit ratio.
While your suggestions make sense on the surface, it does little to change your perception of health care and your perception will still lead to systemic death.
Until you perceive it as a right, then nothing will change and costs will still continue to multiply at the expense of those that can least afford it.
For example, you talk of the individual mandate as a principled anathema to the GOP (even though the concept came out of your think tanks), but removal of the mandate has been tried in Washington in the mid 1990s and this lead to a collapse of the local insurance market.
http://www.seattletimes.com/seattle-news/why-washington-states-health-re...
Washington did attempt to implement their own version of the ACA in the mid 1990s and then, like now, the debate is not centered around the delivery of health care from your end, but the commodization of it and that mentality lead to the collapse of the market.
Even your suggestion of a waiting period to try and maintain something stable puts the onus of risk upon those who are purchasing plans. Your suggestion regarding savings on dropped taxes is again a canard because it could just as easily become a higher profit ratio.
While your suggestions make sense on the surface, it does little to change your perception of health care and your perception will still lead to systemic death.
Until you perceive it as a right, then nothing will change and costs will still continue to multiply at the expense of those that can least afford it.
1
Less silly than current bills. Still silly. Long term ailments - diabetes, mental health, hypertension and other serious but non-fatal heart disease would all become free riders. Heck, I might start a regain your insurance insurance. Pay me a fraction of what full health insurance costs. I'll pay your bills for the waiting period. Then, you get insurance knowing your house has been smoldering. Cheaper than health insurance! Better in every way. Heck I might include annual physicals so you know when to jump.
Mr Douthat, you demonstrate a complete lack of understanding of health care markets. Eliminating the mandate will crush any hope of a viable private market. Next time you decide to write about policy, I suggest you get some very basic education in the matter first. The dilemma for the Republicans is that the hated Obama beat the Republicans to enact the most conservative solution possible to preserve a privated insurance market. Any way they turn to try to repeal, they will precipitate a mess.
1
"So if the party insists on doing something, it should do something appropriately timid. The alternative is a big gamble on a bad bill — not just a crime, but a mistake."
Got it backwards, Douthat.
Now, be still.
Got it backwards, Douthat.
Now, be still.
Douthat jusn't doesn't get why the mandate is important. And yes, no mandate would lead to less coverage. A lot less coverage. There as so many myths and untruths about the healthcare discussion in the U.S. Other countries figured it all out years ago. Follow the money and you'll know why a country that spends more, by far, per capita on healthcare than any other country doesn't come close to covering all it's citizens in a fair and reasonable way.
2
Why are none of these articles about healthcare taking about the FACT that more than half the nation's physicians do NOT participate nor accept Medicaid because the reimbursement rates are so horrendously low? And as the physician shortages worsen (as predicted by every entity on the planet) fewer and fewer doctors will participate in the Medicaid program, as our days only have 24 hours in them and we will fill those up with private insurered, which allow us to pay our bills.
Nothing in what is recommended does anything to really control the rising cost out of healthcare and will not control premium creep. While in average premiums may go down, it is only because at the low end, people are not protected a And still face financial ruin; at the top end, cases is not affordable.
I have considerable sympathy for Trump supporters who were born in the wrong places to the wrong parents and have caught other bad breaks along the way, and I wish them well, but not so much that I wish to be dragged down to their level and have the whole country dragged down alongside me.
If that requires applauding Ryan and McConnell for inflicting their ruinous health plan on the country as a means of awakening sizeable numbers of Trump’s supporters to his betrayal of their interests, then so be it.
Yes, millions of innocents will suffer and chaos will reign.
But you can’t make an omelette without breaking some eggs.
If that requires applauding Ryan and McConnell for inflicting their ruinous health plan on the country as a means of awakening sizeable numbers of Trump’s supporters to his betrayal of their interests, then so be it.
Yes, millions of innocents will suffer and chaos will reign.
But you can’t make an omelette without breaking some eggs.
1
Of course this pointless exercise would also do nothing to lower premiums or deductibles for the non-subsidized individual market, which is exactly the problem the disingenuous GOP is pretending is the reason for Obamacare's collapse and what they are trying to fix. How telling that Douhat doesn't even notice.
It's too late for Republicans to "retreat to modesty", when it comes to this health care bill -- they need to retreat altogether.
It says quite a lot when you work months in secrecy to put out a plan together that no one can agree upon.
It says even more when your own party members start to bail.
But most telling of all, is when a president orders a hit-squad of acrimony against those not willing to go along for the ride.
There's no way of disguising it, the G.O.P. health care bill is a disaster.
It selectively rewards the wealthy, while consigning everyone else to either higher out-of-pocket expenses, or an early grave.
After crowing over seven years about the ineptness of the Affordable Care Act, it's a crime that this is the best the G.O.P. can come up with; and a deceit that the president is championing a "repeal-now-replcase-later" policy that has the potential of placing MILLIONS of American lives in jeopardy.
At this point, there appears to be only three viable options:
Don't get sick.
Don't get old.
Die.
It says quite a lot when you work months in secrecy to put out a plan together that no one can agree upon.
It says even more when your own party members start to bail.
But most telling of all, is when a president orders a hit-squad of acrimony against those not willing to go along for the ride.
There's no way of disguising it, the G.O.P. health care bill is a disaster.
It selectively rewards the wealthy, while consigning everyone else to either higher out-of-pocket expenses, or an early grave.
After crowing over seven years about the ineptness of the Affordable Care Act, it's a crime that this is the best the G.O.P. can come up with; and a deceit that the president is championing a "repeal-now-replcase-later" policy that has the potential of placing MILLIONS of American lives in jeopardy.
At this point, there appears to be only three viable options:
Don't get sick.
Don't get old.
Die.
2
Douthat argues for cuts without rationalizing them ; its reflexive . We have an aging population and a growing population so investment in health care makes more sense. It's an infrastructure issue ultimately . Health care will be to the 21st century what the automobile was to the 20th.
ROSS DOESN'T GET IT. The GOP is in the throes of a civil war between it's extremist factions. I don't know what they would say about their beliefs about the 1% versus the 99%. No matter. The impact of what they do is the massive transfer of wealth from the 99% to the 1%, which will have the effect of causing many in the 99% to sicken and die. The fact is that the 1% will NEVER elect the GOP--any party for that member, with only 1% of the votes. Ross also overlooked the fact that it is highly likely that the GOP will face historic losses in the midterm election.
You can't solve the healthcare conundrum by reducing numbers of payers-in. We all need healthcare at some time, even the optimistic young. Insurance is useful sometimes; I pay for life, auto, fire, earthquake, liability and an umbrella policy to keep my other assets off the table. But I almost never make claims on any of them except healthcare. Which for me is Medicare.
Do I like or think I'll need all these premiums? Guess. But I like peace if mind.
The libertarians of whom you speak say people should be able to forsake peace of mind. Fine. They can skip all but healthcare insurance. But the universal need for healthcare reveals libertarians to be what they really are: I'm having trouble deciding between selfish and anarchist.
Actuarily insurance only works with big buy in. The selfish plan fails because it allows as little buy in as the selfish will accept.
On the other hand, Medicare works just fine because we Wrinklies all buy in. In other words it takes a village, you don't and never did do it all yourself and profit does not = efficiency.
I think Ross's real argument is that his is a politically possible plan. Well California is going to get single payer. It is politically possible here. And now that even Kansas is awakening for its taxophobic stupor, maybe the country will follow the Bear Flag once again.
Do I like or think I'll need all these premiums? Guess. But I like peace if mind.
The libertarians of whom you speak say people should be able to forsake peace of mind. Fine. They can skip all but healthcare insurance. But the universal need for healthcare reveals libertarians to be what they really are: I'm having trouble deciding between selfish and anarchist.
Actuarily insurance only works with big buy in. The selfish plan fails because it allows as little buy in as the selfish will accept.
On the other hand, Medicare works just fine because we Wrinklies all buy in. In other words it takes a village, you don't and never did do it all yourself and profit does not = efficiency.
I think Ross's real argument is that his is a politically possible plan. Well California is going to get single payer. It is politically possible here. And now that even Kansas is awakening for its taxophobic stupor, maybe the country will follow the Bear Flag once again.
99
This proposal may only seem reasonable to someone paying attention to what Republicans are proposing. It will end health care for many and thus still begs us to consider what kind of society we should have. Douthat thinks we should have one in which government hardly smoothes out the historical unfairness, tilted playing fields, lost social mobility, and outlying social harshness of American life. His vision, while characterizing itself as reasoned, is cramped. Think of how our country is the only first world one without socialist medicine. The only one. In that context, this proposal, calling for $250 billion in Medicaid cuts, during an opioids crisis, is just another rightist joke.
1
Your casual statement that eliminating the mandate would lead to less coverage actually translates, in human terms, to many, many more people suffering from lack of health care access. And your per-capita cap on future Medicaid spending would ensure that! The middle class consumers you seem to care about most MIGHT benefit, a little, but the impact of your ideas would be devastating to our country's most vulnerable people - the poor, the ill, the disabled and the aged! So, sorry, but you do NOT have the solution to our health care problem.
3
Conservatives divides Americans into different categories. The very sick, the seldom sick, and the healthy. By using these risk pools they think they can provide enough revenue to cover the system as a whole. Well it doesn't work that way. Funds coming into a hospital, an provider's office, or ancillary services are not marked to go to one place or another. They represent a division that can not cover the expense unless patients die from lack of care or go bankrupt.
The present system was created by the 1973 HMO Act and uses authoritarian methods, benignly called "gatekeepers" to carry out the dictates of insurers. To make real choice in one's care, power has to be returned to the patient. The day of referrals, limited selection of specialists, limited ancillary services must end. Your insurance card should entitle you to visit any practitioner covered by your plan. There should be no punishing co-pays, deductibles, or co-insurance. These are heavier restrictions than the individual mandate ever was.
What needs to be repealed and replace is this 1973 law, not the ACA. This is a time for bold change. In a modern more connected world, this is a matter of justice. Other great changes like women's rights, children's rights, civil rights were too long in coming. We must longer be bullied in order to get care. It is not they we pay too much, but, rather, it is spent to the exclusion of too many.
The present system was created by the 1973 HMO Act and uses authoritarian methods, benignly called "gatekeepers" to carry out the dictates of insurers. To make real choice in one's care, power has to be returned to the patient. The day of referrals, limited selection of specialists, limited ancillary services must end. Your insurance card should entitle you to visit any practitioner covered by your plan. There should be no punishing co-pays, deductibles, or co-insurance. These are heavier restrictions than the individual mandate ever was.
What needs to be repealed and replace is this 1973 law, not the ACA. This is a time for bold change. In a modern more connected world, this is a matter of justice. Other great changes like women's rights, children's rights, civil rights were too long in coming. We must longer be bullied in order to get care. It is not they we pay too much, but, rather, it is spent to the exclusion of too many.
2
"do something that’s big and sweeping and also smart and decent and defensible." Yeah, that would be single payer.
14
Please explain this part: "a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months"; what happens if you get insurance through your employer and are laid off? Although Ms. Conway has asserted that people can just go get new jobs, in my personal experience, that can take longer than two months. Are there details that I'm missing, some sort of COBRA-style insurance extension for people while they seek new employment?
8
When people argue about the cost of universal single-payer health care, do they consider inheritance?
Imagine how much money would have passed down through the generations if our ancestors hadn't spent their last dime on medical care.
Surely, the richest country on Earth can afford what all those poorer countries have long since figured out. Our problem is, Congress works not for the people, but for the money.
Imagine how much money would have passed down through the generations if our ancestors hadn't spent their last dime on medical care.
Surely, the richest country on Earth can afford what all those poorer countries have long since figured out. Our problem is, Congress works not for the people, but for the money.
12
If we are stuck with an insurance approach to paying for health care--likely the worst possible approach--then the most essential feature of a workable system has to be mandated coverage. Anybody who willingly goes uninsured is a deadbeat waiting to stiff providers and leave the rest of us to pick up the bills. The fines for going uncovered have to be larger than expected premiums. Not much chance of that happening with Republicans in control, so we know that whatever comes out of congress won't work.
10
I would bet that the average young/healthy person who wants to skip health insurance pays more for fancy coffee per month than the mandate fee under Obamacare. No car insurance equals no car registration or drivers' licence in most states. And no home owners' insurance means no mortgage from most banks. And we are all perfectly happy to have those insurance policies and never need them. So why are republicans so against buying health insurance even if they don't need it often?
2
My governor, Kasich is on the national stage spouting off in a way Douthat appreciates. But the problem is the governor is not my father, he is my employee and no one, no one in the media asks him about the $1 billion shortfall in Ohio's budget.
BTW media, Ohio is much more than just suburban and exurban white folk.
BTW media, Ohio is much more than just suburban and exurban white folk.
4
I would hardly call the capping of Medicaid spending "going small." It's the biggest thing in the bill, and as Paul Ryan said, the dream of conservatives like him since college. It would gradually end one of the three social "entitlements," the other two being Social Security and Medicare. Medicaid plays a huge role in America's health care economy, not to mention its central role in the out-of-home care of the elderly and disabled. Ross. You need to get out more.
6
"True, eliminating the mandate would lead to less coverage." Too much attention is paid to those who object to the mandate, and not enough to those who actually want to be insured. Even under ACA, if there was no "affordable" policy available (defined as a percentage of AGI), and you made too much for a tax credit, you were "free" to go without insurance. No penalty for you. Great. Under the GOP bills, the threshold AGI to get the tax credit is lower, and individual market premiums for older people are expected to rise. Greater still. So we are "free" to choose to spend an ever larger percentage of income on health insurance, or go without, no penalties for that! This is how Congress interprets Trump's promise to make health care better, it's going to be great health care, and it's going to cost far less?
6
Ross is probably on point from the perspective of what is politically feasible in the present moment.
Its absolutely improbable that the ACA will be allowed to survive because of outright Republican congressional failure.
The ACA was never the final solution to American healthcare. Such an end state is likely multiple iterations down a very rocky road — if it ever truly materializes.
At some point there absolutely needs to be a viable national system that recognizes the incontrovertible assertion that in the pantheon of Life, Liberty, and the Pursuit of Happiness — that LIFE is the most pressing and universal necessity and fundamental human right; that and universal life-long healthcare are inextricably intertwined.
Its absolutely improbable that the ACA will be allowed to survive because of outright Republican congressional failure.
The ACA was never the final solution to American healthcare. Such an end state is likely multiple iterations down a very rocky road — if it ever truly materializes.
At some point there absolutely needs to be a viable national system that recognizes the incontrovertible assertion that in the pantheon of Life, Liberty, and the Pursuit of Happiness — that LIFE is the most pressing and universal necessity and fundamental human right; that and universal life-long healthcare are inextricably intertwined.
14
.....nobody screams about the "mandate" to buy car insurance. We just do it, because it's the right thing to do. Health care is no different.
All of this just gets us closer to single payer. Yay. It's about time.
All of this just gets us closer to single payer. Yay. It's about time.
18
I support single-payer as well. But be careful what you wish for because single-payer has to be fully funded. Look at the British system where the National Health Service is underfunded for the current demand. The local health service trusts are putting caps on available services so that it's become a postcode lottery in the United Kingdom on what health services you can receive. There are multi week waiting periods to see a GP for non-emergency services which is driving people to the emergency rooms for non-emergency care.. Healthcare is expensive and the demand is endless. If it becomes free at point of service, the demand seems to escalate based on the British model.
I'd like at least one respected journalist to ask Mitch McConnell and Paul Ryan on camera that if their plan gets passed, when they'll forgo their excellent taxpayer funded health insurance (and for McConnell, Medicare), and sign up for what they're inflicting upon tens of millions of Americans and legal residents.
20
Excellent point. The columnist does not address the health care benefit that accrue to patients. Nowhere does he talk about patient outcomes. Patient outcomes are what people are concerned about when they get sick. They are not concerned about insurance. They are Concerned about health outcomes for themselves, their families, and their neighbors. The Republicans remind me of officers behind the lines commanding troops into battle. It is not the officers who are being shot.
7
I am a bit surprised that you are advocating lifetime caps per person. The argument between the Democrats and Republicans on health "insurance" is about what health insurance is. The Republicans view health insurance as a growth of expenditures that need to be capped. The Democrats view health insurance as payments to insure certain health services are provided if they prove needed. The Democrats want everyone in the USA to be able to afford these payments, so they want the government to fund the difference between what individuals and families can pay and what these payments cost in the private marketplace. I wonder if the Republicans believe health insurance is about either "health" (services to keep one's health) or "insurance" (payments to protect against unknown future circumstances). It seems that they think it is about budget management. I am all for budget management. The government should focus on how to manage the health insurance budget. Past approaches have focused on capping payments per service. The government through both Medicare and Medicaid does this. And the private health insurers all do this. Why the Republicans want to cut services or worse lie about it by defunding the expected growth in costs without guaranteeing the services (while saying no "cuts" are being made) is beyond me. What are we conserving here? Shouldn't the focus be about conserving the health of Americans? Yes, focus keeping the cost of services down, but don't cut the services.
12
Most Americans never purchase health insurance directly. They are likely to get it via a group program using tax-free funds. Unless they've seen the actual cost via COBRA, most full-time working Americans are blissfully unaware that family insurance is now $17,322 per year. In AK, our most expensive state, it's $1,758 per month average and just $1,184 per month in AR. (source KFF.org)
Arkansas median family income is $51,528. That's $990.92 gross per week, after taxes around $761 or $3,044 per month. Family insurance costs 38% of net income per month. Using it is even harder, deductions can be thousands, and if the primary breadwinner needs time off to recover, that can send those folks quickly into financial default. Arkansas has over 39% of residents who have $0 saved for the future and 68% who have less than $1000 saved.
Why all the math? Because the Republican can't add up. They want the free market to fix the impossible. Recently retiring MoC Mr. Chafftez is complaining that $174,000 per year was not enough. It's no wonder that Congress doesn't understand, for them making over 3.5x over median income is a hardship.
The average working family, note working, can not afford to purchase health insurance. If not for pre-tax payments via employers most would have sticker shock realizing that nearly 40% of their take home pay would go to an insurance company.
The idea that the free market could solve these affordability challenges will never add up.
Arkansas median family income is $51,528. That's $990.92 gross per week, after taxes around $761 or $3,044 per month. Family insurance costs 38% of net income per month. Using it is even harder, deductions can be thousands, and if the primary breadwinner needs time off to recover, that can send those folks quickly into financial default. Arkansas has over 39% of residents who have $0 saved for the future and 68% who have less than $1000 saved.
Why all the math? Because the Republican can't add up. They want the free market to fix the impossible. Recently retiring MoC Mr. Chafftez is complaining that $174,000 per year was not enough. It's no wonder that Congress doesn't understand, for them making over 3.5x over median income is a hardship.
The average working family, note working, can not afford to purchase health insurance. If not for pre-tax payments via employers most would have sticker shock realizing that nearly 40% of their take home pay would go to an insurance company.
The idea that the free market could solve these affordability challenges will never add up.
27
The GOP plan has never been about healthcare - let's all just admit this and move on. It is a tax cut bill. The usefulness of insurance for healthcare is over. That model no longer works. The move to single-payer is inevitable. The only question is how many people will suffer and die before the GOP admits that.
By now we all should know to be wary when Republicans use terms like 'freedom,' 'liberty,' 'choice' and 'free markets.' For the most part, their use of the terms is not about genuine ideological concerns to protect Americans from an oppressive government. Instead, it's a cynical effort to disguise actual intentions: protect powerful health-related industries and their lobbyists. For a corollary example, list to Scott Pruitt at EPA, promise to liberate us from restrictions on known environmental hazards.
8
What if we just ditched O-care by repealing it completely and then wait to see if the people of the country want a replacement?
No one suggests that ''Team Pelosi & Reid'' could have done a repeal-and-rewrite in the two years that Obama had the House of Representatives in his column. They didn't have to - and eighty percent of the country said that they never NEEDED to.
So let's just let this go - either now, or when the damage is complete and 80% of the country can't buy any health insurance because no one is in the market where they live.
This entire sad chapter of our history should have never happened. What it really says is the Lyndon Johnson passed all the cradle-to-grave socialism we'd ever need. He has averaged $500 billion in redistribution per year so far.
No one suggests that ''Team Pelosi & Reid'' could have done a repeal-and-rewrite in the two years that Obama had the House of Representatives in his column. They didn't have to - and eighty percent of the country said that they never NEEDED to.
So let's just let this go - either now, or when the damage is complete and 80% of the country can't buy any health insurance because no one is in the market where they live.
This entire sad chapter of our history should have never happened. What it really says is the Lyndon Johnson passed all the cradle-to-grave socialism we'd ever need. He has averaged $500 billion in redistribution per year so far.
1
The thing is, when, for instance, Exxon -- one of the largest and most profitable enterprises in history -- still receives massive tax breaks, then the "free market" schtick starts to break down a bit. They say that for Exxon, it's incentives to explore, take risks, etc. Why not for working people too?
2
Before the Affordable Care Act, I imagine you were either lucky enough to have good health insurance continuously provided through your employer, have never been laid off and tried to afford COBRA payments (perhaps you have enough $$ in the bank not to worry), and have not had a serious enough ailment to have had insurance declined. As flawed as the existing system may be, returning to the bad old days is not solution.
Obamacare is an excellent solution to a genuine problem that can be highly effective if conservatives spend less time trying to sabotage it in order to justify repealing it, and more time collaborating on perfecting it.
Why does the Party of Lincoln reject "government of the people, by the people and for the people?" They seem to have forgotten why government exists. This might help remind them:
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, *promote the general Welfare*, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."
Why does the Party of Lincoln reject "government of the people, by the people and for the people?" They seem to have forgotten why government exists. This might help remind them:
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, *promote the general Welfare*, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."
1
Eliminate the mandate and the whole thing collapses. I suspect the Republicans could get away with that if they were better organized and led.
5
I believe the mandate for health care facilities to treat all emergency cases is linked to the mandate for individuals to purchase insurance. As long as hospitals are under the mandate to provide services for emergency cases, it is appropriate to require beneficiaries of that mandate to enroll in an insurance plan that covers emergency treatment. Permit individuals to voluntarily decide what additional insurance they purchase in addition to insurance for emergency care.
Such a system is more complex than my simplistic description. Poorer individuals might find emergency care insurance unaffordable and may require economic assistance to purchase insurance. The system would have to precisely and correctly define the term "emergency care." And so on. But linking the two mandates may enable a bipartisan coalition to draft a health care law that preserves individual rights but ensures needed access to health care for all individuals.
Such a system is more complex than my simplistic description. Poorer individuals might find emergency care insurance unaffordable and may require economic assistance to purchase insurance. The system would have to precisely and correctly define the term "emergency care." And so on. But linking the two mandates may enable a bipartisan coalition to draft a health care law that preserves individual rights but ensures needed access to health care for all individuals.
5
How about the "Public Option" option? Have automatic enrollment into the Medicare system with appropriate taxes being deducted from your incomes like Social Security and if some one wants to opt out and get private insurance or have no insurance at all they can do so. Also raise the income cap threshold for SS deductions to $400k.
13
All hospitals are under a mandate to provide emergency services for anyone who shows up at an emergency room. If someone opts out to have no insurance as you suggest, who pays for it? All the rest of us taxpayers. The same goes for a low income poor person or the unemployed. Not having any income to deduct taxes from, who pays for their emergency services when they need it?
2
Or, lift it altogether. Great idea, and I would dearly love to see the Party of the Rich having its collective reaction when ninety or so percent of Americans chose not to opt out. Horrible disappointment to them, since they really want
a) no taxes on the rich, and b) a definitive class sorting, so that the distinctions between them and the serfs are obvious, and unbridgeable.
You know, we are supposed to simply accept our inferiority, and quietly work till we die. For their enrichment.
a) no taxes on the rich, and b) a definitive class sorting, so that the distinctions between them and the serfs are obvious, and unbridgeable.
You know, we are supposed to simply accept our inferiority, and quietly work till we die. For their enrichment.
Just what about this GOP would lead one to believe they could show some restraint? All evidence is to the contrary.
6
Nobody likes to be forced to get auto insurance but somehow Americans manage to do this without controversy. If we add health insurance to the requirements to own and operate a vehicle, we'd all be a lot better to off. I believe in the single payer solution as the only truly successful way to provide health care but if not mandates are the only alternative.
21
As far as I can tell Democrats want single payer, and since they can't get there the ACA is the only alternative. But to save it they need a lot more public money spent on it. They all say it just needs to be "fixed", but any fix being proposed is just more expensive.
Republicans want a cheaper alternative and as the ACA can't survive without more money, they are scrambling for an alternative that 50 senators can agree on. Reminds me of 2010 where the ACA passage needed a few senatorial bribes to get done.
In both cases, the opposition cries and predicts disaster, which in their eyes is unavoidable (and is as long as you choose which disaster).
Ross is correct is his evaluation of the divisions in the Republican Party preventing a sweeping change in health policy, something that's definitely needed.
Republicans want a cheaper alternative and as the ACA can't survive without more money, they are scrambling for an alternative that 50 senators can agree on. Reminds me of 2010 where the ACA passage needed a few senatorial bribes to get done.
In both cases, the opposition cries and predicts disaster, which in their eyes is unavoidable (and is as long as you choose which disaster).
Ross is correct is his evaluation of the divisions in the Republican Party preventing a sweeping change in health policy, something that's definitely needed.
2
One simple tweak to Obamacare would allow everything else to fall into place: When an insured leaves a carrier for any reason, most notably to work elsewhere or take advantage of a lower price, the losing carrier would pay an amount into a clearing fund to cover the cost of caring for then-existing conditions. The new insurer could tap that fund to fund the cost of "covering" those conditions. If insurance is retooled to treat "getting sick" as the insurable event, all of the pieces, including who and what to subsidize, fall into place.
2
The "hated mandate" is part of a libertarian fantasy about how the health economy works. At its core is the problem that people who chose not to purchase insurance don't refuse medical care when they need it. People who don't want to buy car insurance can opt not to own a car. But people who are injured in an accident will be offered medical care in an emergency room, which in most cases can't turn them away because they have no insurance. If a 30 year old is diagnosed with leukemia after bravely declaring s/he is too healthy (or libertarian) to need to bother with insurance, s/he will almost certainly get treated, and rarely do such people bravely declare that having declined to pay into the health care system, they have no right to expect the system to take care of them. There are parts of the health economy in which people can be declined because they can't pay. Pharmacies aren't expected to sell medicines to people who can't pay for them and elective surgery, among other things, is usually not offered to people who can't pay. But there is a health infrastructure that needs to be supported by all citizens because it needs to be there for all citizens, just as a fire department, police department and highway department are. This is why a mandate makes sense. The economic argument, of course, is that it's necessary to maintain the solvency of the insurance funds. That's a separate discussion.
35
Ross, You have it backwards. The mandate is what needs to be kept. As other readers have pointed out, those of us who buy commercial insurance pay for everyone else. We pay through both our premiums, our taxes and our time. Through cost shifting, hospitals, insurance companies and providers offset their unreimbursed care by charging more to the insured. The insured pay taxes to state and local governments to cover the cost of the uninsured. Emergency rooms are packed with uninsured patients getting routine care for chronic conditions, which causes delays in care for those of us with insurance.
Most states require auto insurance, but we still have to pay an extra charge for "uninsured motorists coverage". This often amount to 10-20% of the total premium. It can be easily extrapolated to calculate a similar percentage to health coverage to understand a fraction of what the uninsured cost the rest of us. The idea of the mandate was to get the largest possible pool of people insured,so to spread risk, that's how insurance works. We have plenty of people who cannot afford to buy even a minimal policy, the government can help them through existing programs. Everyone else needs to step up and buy insurance so rates can come down, as may taxes, and we can spend less time in ERs getting quicker and less costly care care.
If you had spent any time in a large city ER or worked in health care,you would have seen the day to day issues involved in actually caring for people.
Most states require auto insurance, but we still have to pay an extra charge for "uninsured motorists coverage". This often amount to 10-20% of the total premium. It can be easily extrapolated to calculate a similar percentage to health coverage to understand a fraction of what the uninsured cost the rest of us. The idea of the mandate was to get the largest possible pool of people insured,so to spread risk, that's how insurance works. We have plenty of people who cannot afford to buy even a minimal policy, the government can help them through existing programs. Everyone else needs to step up and buy insurance so rates can come down, as may taxes, and we can spend less time in ERs getting quicker and less costly care care.
If you had spent any time in a large city ER or worked in health care,you would have seen the day to day issues involved in actually caring for people.
20
Seems no one objects to saving all Americans from foreign threats by financing defense. Why are health threats different?
21
I am so tired of the same old arguments about health care. If you reduce premiums, copays and deductibles go up. If you raise premiums, copays and deductibles go down. Either way there is no cost-effective and medically effective solution for health care if you continue to treat it as a "market" and a for-profit "business." I wish someone in our government would ask the CBO to estimate the cost and savings in a single-payer system like Medicare for all with supplemental insurance for those who want a supplement. That way we would learn what other civilized countries in the world learned long ago.
37
I couldn't agree more. I have always wondered why there could not be some type of CBO scoring for a variety of possible proposals; including single payer.
I am not the only person that can see that the current debate about the Republican debate has nothing to do with health care. My hope is that someday our country will be willing to push for a conversation about taking care of its citizens instead of being nasty and counter the others at all costs. The people will get nothing good if we don't.
I am not the only person that can see that the current debate about the Republican debate has nothing to do with health care. My hope is that someday our country will be willing to push for a conversation about taking care of its citizens instead of being nasty and counter the others at all costs. The people will get nothing good if we don't.
12
Jonathan Swift might not think that Ross' "Modest Proposal" is quite enough modest, but affirming a waiting period before health insurance could be purchased for those who chose to forgo health insurance and suddenly find that decision might not have been the best, certainly does have just enough cruelty and potential for catastrophe to meet the test for "modesty." Let us affirm our freedom from onerous mandates as we celebrate our "modesty" on this Independence Day!
9
All of this is just a dress rehearsal for the real legislative battle to come, namely, the conversion to a single payer health insurance system. Everyone will eventually love this system, including employers who will no longer have to pay health insurance for their employees, and individuals who also will no longer be "forced" to buy insurance. Instead, everyone will be insured for life from their date of birth. The system will be paid for via federal taxes, just like Medicare. If there are "losers," they will perhaps be the insurance companies, but they will certainly have contracts (at a regulated profit margin) to administer the national program across all 50 states. Yes, the single insurer will tend to "control" prices via its monopsony position (there will no longer be an insurance "market"), but this is not "socialized medicine" and private providers of health services and products will still operate at a reasonable profit.
There will be a battle royal on single payer, but the balance will tip in its favor particularly when employers, hospitals, the medical associations and all individuals (employed or not) advocate its adoption. Again, this is not some kind of communist/socialist plot but a normal way to set up a health system -- we are the only advanced country in the world that hasn't adopted it already.
There will be a battle royal on single payer, but the balance will tip in its favor particularly when employers, hospitals, the medical associations and all individuals (employed or not) advocate its adoption. Again, this is not some kind of communist/socialist plot but a normal way to set up a health system -- we are the only advanced country in the world that hasn't adopted it already.
24
Ross, you should just admit that Republicans do not believe in any kind of shared health care? It should be provided by your benevolent employer (and that employer really should raise your retirement age by a couple of years). You guys have had at least 7 years to come up with a plan, but you really don't have any plan at all. The rest of the developed world figured out health care about 50 years ago (single payer/government health care), but we are not even close to the rest of the developed world on this one and we will never be.
15
Ross continues to pretend the Ryan-McConnell machine is interested in the good of its voters. But nothing suggests that. They are interested in maintaining their financial and other support from a group of theocratic billionaires, and will go to any lengths to obey their masters.
Ross has his short list of what he estimates they could pass, but their sponsors' objective does not require passage of anything. The goal is government dysfunction, and that already has been largely achieved whether the ACA dies a facilitated death or a more expedited one.
Ross has his short list of what he estimates they could pass, but their sponsors' objective does not require passage of anything. The goal is government dysfunction, and that already has been largely achieved whether the ACA dies a facilitated death or a more expedited one.
9
I think the problem with this incremental proposal is that this isn't really about fixing or strengthening health care, it's about a complete repudiation of Obama, for the base of voters that hate "Obamacare" because it's something that "the Muslim Kenyan black guy" accomplished. Approaching such a base with something rational is a doomed effort. This approach would require Republicans to actually lead, rather than pander. So far, they haven't demonstrated that ability at all.
I think both Dems and Republicans realize that improving what is already in place would make sense, but again, it's that leadership thing that the R's can't seem to muster.
I think both Dems and Republicans realize that improving what is already in place would make sense, but again, it's that leadership thing that the R's can't seem to muster.
85
Mr. douthat misses the point of the republican 'health care' bill. Republicans want only to wring enough money out of the system to pay for a huge rich man's tax cut. Nothing else matters.
So if you limit Medicaid cuts what will these poor rich people do? Cut back on their overseas bank accounts? Cut back on dividends to their rich stock holders? Send some more factories overseas? cut back on that extra yacht? How depressing for them, but deadly for the rest of us.. The rich will only settle for the full monti.
So if you limit Medicaid cuts what will these poor rich people do? Cut back on their overseas bank accounts? Cut back on dividends to their rich stock holders? Send some more factories overseas? cut back on that extra yacht? How depressing for them, but deadly for the rest of us.. The rich will only settle for the full monti.
11
just Robert--They are not missing the point. They know exactly what they are doing. YOU make the mistake of thinking that Republicans actually want to "serve the people," as they were elected to do. This is a TAX overhaul, favoring rich people, not a health care bill that serves ALL Americans. THAT is pretty simple, and easy to understand.
9
You need a mandate for the same reason we have income tax withholding: people need to be saved from the self inflicted situations where they drop insurance (don't save enough to pay tax) until they get sick (have to pay tax), causing pain for both them and the government. Seems like Republicans could grasp this simple concept.
10
One year ago I was diagnosed with stage 4 cancer. Even tho I had a full time job, there was no way I could afford expensive cancer operations, chemo and radiology. I got Medicaid as I was unable to work, and Obamacare has extended my life for two extra years. I will always be grateful to Mr. Obama and his staff for giving more time with my family.
In the face of the cruel, heartless republican bill, Sen Dean Heller bravely refused to support the huge tax cuts for the rich. I hope he stands strong, as he quickly received calls from Steve Wynn and Sheldon Adelson to back off. We will see if he stands for his constituency or caves to the pressure of big money.
In the face of the cruel, heartless republican bill, Sen Dean Heller bravely refused to support the huge tax cuts for the rich. I hope he stands strong, as he quickly received calls from Steve Wynn and Sheldon Adelson to back off. We will see if he stands for his constituency or caves to the pressure of big money.
18
There are only two philosophically legitimate options.
The first one is government mandated universal coverage.
The second which unfortunately is political suicide but is true to conservative core values is staying out of healthcare entirely and leaving healthcare in the hands of private insurers. This of course means that most of my high risk demographic , those of us over 65 will be uninsurable and will die sooner rather than later which will of course leave social security another conservative beet noir open to repeal.
One hundred years ago life expectancy was after all less than 60 and taxation was very very low. Those certainly were the good old days for conservatives , you got sick you died and the government didn't have to worry about old age security and healthcare.
The first one is government mandated universal coverage.
The second which unfortunately is political suicide but is true to conservative core values is staying out of healthcare entirely and leaving healthcare in the hands of private insurers. This of course means that most of my high risk demographic , those of us over 65 will be uninsurable and will die sooner rather than later which will of course leave social security another conservative beet noir open to repeal.
One hundred years ago life expectancy was after all less than 60 and taxation was very very low. Those certainly were the good old days for conservatives , you got sick you died and the government didn't have to worry about old age security and healthcare.
8
Thanks Ross for coming up with another conservative plan to deny a few million Americans access to healthcare. Once again we have a conservative wonk proposing a solution to healthcare which ignores the central problem. Americans are paying twice as much for healthcare now and Congress seems perfectly happy for that to continue. Here's a simple Incremental idea. Have Congress tell the drug companies and Epipen crooks and their ilk that Americans are going to pay the same amount as Canadians. Simple. It saves something over a hundred billion dollars a year, which would go a long way toward paying for all the new Medicaid coverage. Then Congress could figure out how to cut Americas three trillion dollar yearly medical bill in half while covering everybody, just like Donald Trump said he would and just like every other advanced country does.
18
Great idea! Why has no one thought of that before. ....
Tell the doctors, nurses, technicians, management etc that they will ALSO be paid at the same rate as the rest of the world...
Don't stop after you gore one ox...
Perhaps you will brand the medical community "fat cats and greedy pigs.... to justify this policy and win the politics as you doing with the pharm industry! (Attacking Marcus Welby and your doc as a fat cat or greedy pig will certainly work)
Perhaps you will call this policy "Wage and Price control" as Nixon did..... Perhaps you will try the Obama term "Bend the cost curve" His answer was to take on the insurance industry portion of the problem and negotiated a fixed cap on profit for these companies. Half the country wants that policy repealed..... they also want a unicorn
Bottom line.... you need a smarter policy to solve this problem.
Tell the doctors, nurses, technicians, management etc that they will ALSO be paid at the same rate as the rest of the world...
Don't stop after you gore one ox...
Perhaps you will brand the medical community "fat cats and greedy pigs.... to justify this policy and win the politics as you doing with the pharm industry! (Attacking Marcus Welby and your doc as a fat cat or greedy pig will certainly work)
Perhaps you will call this policy "Wage and Price control" as Nixon did..... Perhaps you will try the Obama term "Bend the cost curve" His answer was to take on the insurance industry portion of the problem and negotiated a fixed cap on profit for these companies. Half the country wants that policy repealed..... they also want a unicorn
Bottom line.... you need a smarter policy to solve this problem.
The basic Republican problem is smallness alright - smallness of heart and soul. They really don't want to give healthcare to anyone so there lies the quandary. Lies is right too - they have to convince people that they want to help when they're actually going to be causing many thousands of earlier deaths, just for starters.
5
1) Eliminating the health insurance industry will at once save about 20% (the insurance industry’s 30% less the 10% it costs to administer Medicare). The healthcare insurance industry are parasites who add nothing, zero, to good healthcare, so why keep them in the equation?
2) Pay via a payroll tax of say 1% for employees & 1% for employers, & maybe 0.5% for the employee for each non-employed dependent. This is via payroll deduction or on your income tax each year. This would not be onerous, e.g., $2,500 per year for a person making $100k & with a dependent spouse & two children. Remember, you will not also have to pay an additional premium unless you elect a secondary private policy (this is where the healthcare insurance industry can compete). Employers who provide health benefits as an employment inducement should love a plan like this: instead of paying an employer share of $300-500 a month ($3,600-6,000 per year) per employee in my example (when the cost is split), they would pay $2,500 and, if so magnanimous, could even be allowed to pay the employee share & still probably save money.
3) Pharma & medical costs must be contained along with fraud, waste, & abuse … I gather that Medicaid fraud is now in excess of 50 billion a year!
Last, I thank Mr. Douthat for sharing his views and I know he was trying to make a specific point, but I would love to see him, and others, do a follow-up article that considers & responds to the comments his article generated.
2) Pay via a payroll tax of say 1% for employees & 1% for employers, & maybe 0.5% for the employee for each non-employed dependent. This is via payroll deduction or on your income tax each year. This would not be onerous, e.g., $2,500 per year for a person making $100k & with a dependent spouse & two children. Remember, you will not also have to pay an additional premium unless you elect a secondary private policy (this is where the healthcare insurance industry can compete). Employers who provide health benefits as an employment inducement should love a plan like this: instead of paying an employer share of $300-500 a month ($3,600-6,000 per year) per employee in my example (when the cost is split), they would pay $2,500 and, if so magnanimous, could even be allowed to pay the employee share & still probably save money.
3) Pharma & medical costs must be contained along with fraud, waste, & abuse … I gather that Medicaid fraud is now in excess of 50 billion a year!
Last, I thank Mr. Douthat for sharing his views and I know he was trying to make a specific point, but I would love to see him, and others, do a follow-up article that considers & responds to the comments his article generated.
45
Instead of spending your time, and wasting ours, by trying to come up with a plan that is palatable to the Republicans and their billionaire supporters, you should just admit that a single payer system is the only fair and equitable plan that takes care of everyone's needs. Your plan is just another variation of the wolf in sheep's clothing.
4
Ross, there you go again. Cut taxes. Pay for the tax cuts with Medicaid cuts. Send those forced off Medicaid to the Emergency Room. Declare victory and take victory lap on the wealth donor circuit. Sounds like a vintage GOP plan.
6
The Republican free market solution--the idea that people can shop as good consumers for their plans, and thereby drive down costs through competition--is ludicrous.
First, insurance policies are incomprehensible and full of loopholes; there is no way to be a sensible consumer in regard to them. Arguing with insurance company bureaucrats when you're sick is one of the most awful features of this current system.
Second, no one can make a good, well-informed decision about how much insurance they might need. We don't know how long we're going to live, we don't know what disease might strike us down, we don't know whether we'll be in a serious car accident.
Medicare for all makes sense. Continuing to subsidize insurance company profits does not.
First, insurance policies are incomprehensible and full of loopholes; there is no way to be a sensible consumer in regard to them. Arguing with insurance company bureaucrats when you're sick is one of the most awful features of this current system.
Second, no one can make a good, well-informed decision about how much insurance they might need. We don't know how long we're going to live, we don't know what disease might strike us down, we don't know whether we'll be in a serious car accident.
Medicare for all makes sense. Continuing to subsidize insurance company profits does not.
9
"It would replace it [the mandate for insurance], as the Senate bill does, with a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months."
This is merely a repackaging of a "mandate," but with a steeper (and potentially life-threatening) penalty.
Both the mandate and the requirement have the same intention: create a punitive incentive for everyone to buy insurance even when they're healthy, to keep the overall market affordable. With the Dem's mandate, the penalty is a modest tax increase if you forego buying insurance; but if you get sick, you can still purchase somewhat affordable insurance. But the Rep's penalty is: If you get sick, you're forbidden to buy insurance for six months, which forces you to pay astronomical medical bills out of your own pocket; or, if you can't afford to pay those astronomical medical expenses, sorry, but there's no way for you to receive medical care.
Most people cannot afford to pay tens of thousands of dollars for a broken bone; or hundreds of thousands of dollars for cancer. What are those people supposed to do? Wait six months for treatment? And for the poorest people, even bringing a child in for a sore throat or an ear infection can cost hundreds of dollars, which they can't afford; the Rep's plan will force these families to avoid going to the doctor, which risks serious permanent injuries, epidemic outbreaks, etc.
It's insane and cruel! Don't they understand this?
This is merely a repackaging of a "mandate," but with a steeper (and potentially life-threatening) penalty.
Both the mandate and the requirement have the same intention: create a punitive incentive for everyone to buy insurance even when they're healthy, to keep the overall market affordable. With the Dem's mandate, the penalty is a modest tax increase if you forego buying insurance; but if you get sick, you can still purchase somewhat affordable insurance. But the Rep's penalty is: If you get sick, you're forbidden to buy insurance for six months, which forces you to pay astronomical medical bills out of your own pocket; or, if you can't afford to pay those astronomical medical expenses, sorry, but there's no way for you to receive medical care.
Most people cannot afford to pay tens of thousands of dollars for a broken bone; or hundreds of thousands of dollars for cancer. What are those people supposed to do? Wait six months for treatment? And for the poorest people, even bringing a child in for a sore throat or an ear infection can cost hundreds of dollars, which they can't afford; the Rep's plan will force these families to avoid going to the doctor, which risks serious permanent injuries, epidemic outbreaks, etc.
It's insane and cruel! Don't they understand this?
4
Americans cannot drive a car without insurance, cannot get a mortgage without insurance and should not be permitted to go without health insurance. People who equate freedom with choosing to go without health insurance are irresponsible freeloaders. When they get sick, and they will get sick, they show up in the emergency room demanding treatment that they have no means or intention to pay for. Their bad debt is then redistributed to paying patients raising the cost for everyone. This basic reality, of economics and human behavior, has escaped the Republicans.
12
"The Medicaid per-capita cap would be an experiment". An experiment tests a theory, and here the theory is that sick needy people can endure without medical coverage adequate for a full life. Or is the theory merely that the American public will tolerate meager help for the poorest among us? Either is a cynical basis for declaring "victory". These are the kind of "victories" you wish on an enemy.
1
We require drivers to buy car insurance. I don't see anything wrong with requiring citizens to buy health insurance. Your health is a public liability. The problem is the options under Obamacare are often burdensome to the consumer. Mr. Douthat's solution is to remove the burden rather than provide better options. That's like giving the dog a treat when it barks rather than training the dog not to bark. Lazy and irresponsible. Mr. Douthat shouldn't own a dog; Republicans shouldn't own health care. They lack the moral empathy to create anything but disaster.
6
The Republicans had seven years to come up with a worthy plan. And see what they've concocted. Ross, other countries are laughing at us.
2
Ross, you continue to insist the Ryan-McConnell machine wants to improve healthcare. There is no evidence for that. You have your little list of what should be done. There are many more helpful things that could be done.
Ryan-McConnell know all this. They don't care.
Ryan-McConnell know all this. They don't care.
6
Seriously, Ross? "Much of any drop-off would be genuinely voluntary." So you're saying much of it would not be. So you're willing to let an untold number of people lose their health insurance just for some mushy "conservative principles"?
As for your framing device, that the Democrats should have "gone small" in 2010, what would that have looked like? The ACA borrowed conservative principles in order to get GOP votes, but the GOP was already committed to saying no to anything Obama proposed. There would have been no point to going small.
To compare the Democrats' genuine desire to give people health insurance to the GOP desire to take it away from people is a disgrace, Ross.
As for your framing device, that the Democrats should have "gone small" in 2010, what would that have looked like? The ACA borrowed conservative principles in order to get GOP votes, but the GOP was already committed to saying no to anything Obama proposed. There would have been no point to going small.
To compare the Democrats' genuine desire to give people health insurance to the GOP desire to take it away from people is a disgrace, Ross.
6
In time, hopefully not hundreds of years, the GOP will come to terms with their beliefs about working people. In order for there to be a labor pool for the ridiculous, mundane, and soul killing jobs, created by the GOP donors, the workers must be keep on edge, cold and hungry, with the choice but to take these pathetic jobs. The government must not ease the pain of workers, they must be brought to their knees; they are unworthy of the government help that the GOP lavishes on it's donors. If you doubt this, name one industry that was successful without tax breaks or some government hand out to prop up the business. What progressives need to do is stop calling what the GOP does cruel. It is cruel, but it is more importantly, the dumbest way ever to treat workers, or maximize their ability to produce goods and services within the whole economy. It will in time be understood that the most absurd thing in the world, was believing that the GOP had ideas that were applicable and appropriate to the lives of the working class. The strangest thing of all is to think what is being asserted here is radical. It's "just the facts mam, just the facts." THE POOR ARE NOT PICKING YOUR POCKET; THERE IS MORE THAN ENOUGH TO GO AROUND.
2
For those of us with decent health care plans like Mr. Douthat, our ignorance of the plight of those without it, who depend on Medicaid, is apparently bottomless. It's time to go big...single payer and put everyone on Medicare and let the superrich pay taxes equivalent to the tax breaks that they get to pay for it.
1
Ross's proposed small ball bill for Republican health care reform is just more Obamacare lite. We need real reform. We need a voucher/tax credit program and nothing else.
Give each individual a $6000 and each family a $12000 voucher/tax credit. They can take it to their employer or out on the open market. If their premium cost are above the limit, it would be coming out of their pocket or would be taxable income if paid by their employer. Insurance companies' plans would have to be a la carte and open to all - no special plans for Goldman Sachs or members of Congress. Medicaid would be terminated. Medicare would continue with everyone getting the same voucher/tax credit with a senior premium, say to $18000.
Simple and market driven. The middle class would go nuts, but everyone would finally be in the same boat leading to the long overdue reforms to the insurance and health care markets.
Give each individual a $6000 and each family a $12000 voucher/tax credit. They can take it to their employer or out on the open market. If their premium cost are above the limit, it would be coming out of their pocket or would be taxable income if paid by their employer. Insurance companies' plans would have to be a la carte and open to all - no special plans for Goldman Sachs or members of Congress. Medicaid would be terminated. Medicare would continue with everyone getting the same voucher/tax credit with a senior premium, say to $18000.
Simple and market driven. The middle class would go nuts, but everyone would finally be in the same boat leading to the long overdue reforms to the insurance and health care markets.
now, everyone and his dog knows what the Republican/Trump strategy is: Repeal Obamacare now and talk about how they'll replace it somewhere out in the vague future with "something great." When the subject comes up out in the vague future - which it seldom will - they'll blame the Democrats and immigrants for the body count.
There are many small-ball things that should be pursued immediately, and those range from opening state-regulated markets to competition or speeding more drugs into generics. The big-bang approach, favored by Democrats (see Hillary and Obama) is all a ruse to get to nationalized health care. If health care is going to balance the desire for freedom and cost effectiveness, it needs to connect a person's decisions and choices to the cost of their health care.
And whatever happens, the Republicans (whether you favor them or not) have got to bring the Democrats into this morass of their creation and return big decisions to bipartisan debate.
This country needs to be run by Moderates. Not the Republicans. And not the typical hair-on-fire Progressive commenters that hang around the NYTimes comments section.
And whatever happens, the Republicans (whether you favor them or not) have got to bring the Democrats into this morass of their creation and return big decisions to bipartisan debate.
This country needs to be run by Moderates. Not the Republicans. And not the typical hair-on-fire Progressive commenters that hang around the NYTimes comments section.
I am curious: what do think should happen if someone uninsured starts hemorrhaging, for example, has emergency scope done, and is found to have a tumor or blockage? Should they skip the surgery for two. O this until they can get insurance? Or do we still bankrupt them? Remember, once out of ER and into surgery or hospital bed, the laws about ER care do not apply.
1
Might one solution be to open to all citizens the excellent health care insurance plan offered to all US government employees and to families of Congress members? It is almost identifcal in coverage and in underwriters to the plan offered to the employees of most US large companies.
One additional change might be to allow individual taxpayers to fully deduct premiums (up to a sensible maximum) from their taxable income. Now medical expenses (including insurance premiums) are deductbile for individuals only to the extent that they exceed 7.5% of gross income.
The same restriction does not apply to employers who deduct that part of such premiums which they pay and declare.That is really quite stupid, since anyone but an absolute fool knows that so-called "benefits" are really part of wage or salary compensation masked as something else.
One additional change might be to allow individual taxpayers to fully deduct premiums (up to a sensible maximum) from their taxable income. Now medical expenses (including insurance premiums) are deductbile for individuals only to the extent that they exceed 7.5% of gross income.
The same restriction does not apply to employers who deduct that part of such premiums which they pay and declare.That is really quite stupid, since anyone but an absolute fool knows that so-called "benefits" are really part of wage or salary compensation masked as something else.
2
"True, eliminating the mandate would lead to less coverage." This is a gross misstatement of a calamity. Bare bones healthcare insurance with huge deductibles is not a healthcare plan that the poor can afford.
Republican plans for cutting costs don't actually cut costs, they cut the number of people that can afford expensive healthcare. How about cutting costs! Do it with a single payer system where the manager of the plan can negotiate prices with the providers. Eliminate the truly evil price structure imposed on Americans by big Pharma and big Medicine -- exactly the same care in single payer countries costs less.
But big Pharma, big medicine, and all big business has Congress, not just Republicans wrapped around their little fingers. Congress persists in the belief that big profits for big business means that the country is in great shape. Medical care is in a shambles. Cut costs, not the amount of care or the number of people that can afford it.
Republican plans for cutting costs don't actually cut costs, they cut the number of people that can afford expensive healthcare. How about cutting costs! Do it with a single payer system where the manager of the plan can negotiate prices with the providers. Eliminate the truly evil price structure imposed on Americans by big Pharma and big Medicine -- exactly the same care in single payer countries costs less.
But big Pharma, big medicine, and all big business has Congress, not just Republicans wrapped around their little fingers. Congress persists in the belief that big profits for big business means that the country is in great shape. Medical care is in a shambles. Cut costs, not the amount of care or the number of people that can afford it.
1
It would be nice if Ross actually took seriously the power-game in play rather than pretend to go wonky on insurance premiums and the like.
Republican politicians could not care less about health care for the masses, or social security or Medicare. Why? They have their own publicly-subsidized Cadillac-care health insurance which they legislated for themselves. Now you go take care of yourself. It is just that small and selfish.
This is class warfare plain and ugly. Republicans will pander to their corporate donor paymasters and all the other high-rolling bribers who actually set national policy.
The Republican's capitalist binging is out of control, and that may inspire a revolt that swings toward socialism. It nearly happened before in the Great Depressions when the nation turned to FDR.
Republican politicians could not care less about health care for the masses, or social security or Medicare. Why? They have their own publicly-subsidized Cadillac-care health insurance which they legislated for themselves. Now you go take care of yourself. It is just that small and selfish.
This is class warfare plain and ugly. Republicans will pander to their corporate donor paymasters and all the other high-rolling bribers who actually set national policy.
The Republican's capitalist binging is out of control, and that may inspire a revolt that swings toward socialism. It nearly happened before in the Great Depressions when the nation turned to FDR.
3
The Republicans have been voting to repeal the ACA for the last seven years. And yet as you point out , here it is seven years later and they can not agree on a replacement.
So despite their call to Repeal and Replace they NEVER had any plan to replace it. And they still do not 8 months after the election was won. Why anyone thinks that they will pass anything in the near future except some disastrous rush job is beyond me.
ently
Remember that Boehner recently said that Republicans have never been able to agree on health care for the last 20 years!
So despite their call to Repeal and Replace they NEVER had any plan to replace it. And they still do not 8 months after the election was won. Why anyone thinks that they will pass anything in the near future except some disastrous rush job is beyond me.
ently
Remember that Boehner recently said that Republicans have never been able to agree on health care for the last 20 years!
It sounds a lot like freedom and taking responsibility to eliminate the mandate, doesn't it? Except that ultimately, other than the consequence of being really sick and getting sicker because something like, say colon cancer, is not caught early and then costs much, much more to treat when it is advanced. So what happens when those free-wheeling libertarians end up in this situation, having bankrupted their own resources? Do they smile and die, knowing that it was their own choice not to have health care? Nah. Same with the folks in Kentucky who saw it as an infringement of freedom to be required to wear a motorcycle helmet. Someone, ultimately, pays in the form of higher costs passed onto others, higher insurance premiums and deductibles, etc.
The cool thing about the mandate is: it's honest. You WILL need medical care at some point and if you wait until you are sick you will not be able to afford to pay the costs on your own. It's the only thing that will make a plan like the ACA work, by increasing the pool.
It's not what I'd want. I'd like something larger with private insurance available as it is in the case of Medicare for people who want more, but everybody covered at a basic level and some way to reduce costs.
The cool thing about the mandate is: it's honest. You WILL need medical care at some point and if you wait until you are sick you will not be able to afford to pay the costs on your own. It's the only thing that will make a plan like the ACA work, by increasing the pool.
It's not what I'd want. I'd like something larger with private insurance available as it is in the case of Medicare for people who want more, but everybody covered at a basic level and some way to reduce costs.
3
Seriously, healthcare coverage should be mandated. Going without it is as irresponsible as driving a car without collision coverage. Freedom to be irresponsible is not an inalienable right.
3
One of the biggest costs for everyone is Prescription Drugs. I would rather see Congress do something about the every higher cost of Prescription Drugs than haggle over who pays for what health care insurance and what should be in the plans.
No point in dreaming about Medicare for all - not going to happen. But bringing down the cost of Prescription Drugs would be really important. If that could be dealt with, we could just let the ACA limp along as it is.
No point in dreaming about Medicare for all - not going to happen. But bringing down the cost of Prescription Drugs would be really important. If that could be dealt with, we could just let the ACA limp along as it is.
You're making it way too complicated. Healthcare is like food security. No one in this country should be starving or without medical care when they are sick.
Everyone needs insurance. Everyone has to be in. Giving individuals a waiting period after they're sick before they have a benefit means they put off care and get sicker, or go into debt or bankruptcy. Not acceptable.
Letting insurance companies make "Swiss cheese" policies that omit core benefits results in people finding out that their mental health problem or cancer illness isn't covered when they need the benefit. Then they again go without care or go into debt or bankruptcy. Not acceptable.
The simplest solution is Medicare for all, and yes that means defining what the limits of care are, we don't have unlimited dollars. And those with means can purchase amenity policies or premium care directly. If not Medicare for all then Singapore and Switzerland have managed marketplace models that we can borrow from to create a US model.
But everyone needs to pay in, everyone needs coverage for core medical needs, available when they get sick. The system has to have a single payer government regulated program or a very regulated private sector variation. BTW a VAT would be a good way to fund it, though that's another controversy.
Everyone needs insurance. Everyone has to be in. Giving individuals a waiting period after they're sick before they have a benefit means they put off care and get sicker, or go into debt or bankruptcy. Not acceptable.
Letting insurance companies make "Swiss cheese" policies that omit core benefits results in people finding out that their mental health problem or cancer illness isn't covered when they need the benefit. Then they again go without care or go into debt or bankruptcy. Not acceptable.
The simplest solution is Medicare for all, and yes that means defining what the limits of care are, we don't have unlimited dollars. And those with means can purchase amenity policies or premium care directly. If not Medicare for all then Singapore and Switzerland have managed marketplace models that we can borrow from to create a US model.
But everyone needs to pay in, everyone needs coverage for core medical needs, available when they get sick. The system has to have a single payer government regulated program or a very regulated private sector variation. BTW a VAT would be a good way to fund it, though that's another controversy.
2
That's it. Financial ruin and/or death because you got sick or had an accident after you forgot to buy new insurance between jobs or renew your policy or simply lost your job and had other things on your mind seem to be an awfully harsh penalty in what we like to call a civilized society.
1
I don't understand the logic of keeping people from repurchasing insurance if they let it lapse. You want people in the market. The Obamacare penalty is less draconian and punitive.
2
One of many problems with this proposal is that people who opt out of insurance still need medical care in an emergency. Thus, when something calamitous happens to an uninsured person, the consequences are dire, and not only for the uninsured person who is ill. Don't forget the hospital who does not turn that patient away -- hospitals don't and can't turn people away when they are in an emergency -- and is then stuck having delivered services that cannot and will not be paid for. The waiting period is nonsensical and terribly damaging to hospitals.
2
Medical Device companies Should be Taxed! I know, I've worked w many of them via Stanford Med. Ctr. Their inventors will become extremely rich if their device(s) goes to market and it's not like these entrepreneurs don't already have large super wealthy investor launching new devices.
Why shd medical devicesNOT pay tax? Does this mean Apple should not pay taxes when it launches a new product? What about Sony or GE, Ford, etc?
Why shd medical devicesNOT pay tax? Does this mean Apple should not pay taxes when it launches a new product? What about Sony or GE, Ford, etc?
2
I am not allowed to drive on public roads without liability insurance. Not because it protects me, but because it protects society. However, if I have no medical insurance and end up in the ER, perhaps a coma and long stay hospital stay, the burden falls upon society.
Republicans always rally around the concept of individual freedom. But, that freedom should have limitations when it adversely affects the rights of others. The right of someone to choose not to get health insurance sounds like free choice, but it is actually a choice to impose risk costs on society.
BTW, Ross, what does your health-care light recommendations do to lower premiums, lower deductibles, lower co-pays, lower costs of medical services? Even if you reduce the McConnell and Ryan $800 billion in cruel cuts to Medicaid, what does the $250 billion translate to in human suffering?
Seems to me your Douthat Healthcare bill is much like the Republicans' replace bills, the real purpose is not to provide affordable healthcare to America, but to please donors, deceive/mollify the base, win elections and stay in power to continue the Republican charade of governance.
Republicans always rally around the concept of individual freedom. But, that freedom should have limitations when it adversely affects the rights of others. The right of someone to choose not to get health insurance sounds like free choice, but it is actually a choice to impose risk costs on society.
BTW, Ross, what does your health-care light recommendations do to lower premiums, lower deductibles, lower co-pays, lower costs of medical services? Even if you reduce the McConnell and Ryan $800 billion in cruel cuts to Medicaid, what does the $250 billion translate to in human suffering?
Seems to me your Douthat Healthcare bill is much like the Republicans' replace bills, the real purpose is not to provide affordable healthcare to America, but to please donors, deceive/mollify the base, win elections and stay in power to continue the Republican charade of governance.
3
The individual mandate is essential. Otherwise, unless a younger person is very well off the best bet is to not carry insurance, and if you get a bad illness just show up at a hospital and get treated for free. The hospital can come after your money, but then just declare bankruptcy because you aren't losing much. It's a gamble worth taking.
Younger people who pay through the individual mandate don't understand one of the main benefits they acquire---that benefit being that their parents and grandparents can get insurance. Without that insurance for the parents and grandparents many of them will be paying for family members' medical treatments.
If I was young, I would consider not purchasing insurance and just waiting for everything to blow up and we finally go to a single payer system. I'd be money ahead under that scenario.
Younger people who pay through the individual mandate don't understand one of the main benefits they acquire---that benefit being that their parents and grandparents can get insurance. Without that insurance for the parents and grandparents many of them will be paying for family members' medical treatments.
If I was young, I would consider not purchasing insurance and just waiting for everything to blow up and we finally go to a single payer system. I'd be money ahead under that scenario.
2
Without the mandate, many younger healthier people would not buy insurance - causing premiums to rise. And people who do get sick generally need healthcare right away - not after 6 months. A larger subsidy pool for extremely high cost insured individuals would be a good idea. Lastly, insurance companies should only be able to charge a per person amount of cost above the actual healthcare cost rather than a percentage. For instance - $200 per person enrolled rather than 20% above healthcare costs. By leaving this as a percentage every time healthcare costs go up so does what insurers make as profits - even though they are doing no more 'work'. Since healthcare costs go up much faster than general inflation insurers that 20% is a lot more money & that just adds even more to the rapid inflation of premiums. None of this really matters to republicans though since what they really want to do is what they always want to do - give tax cuts to the wealthiest people.
1
How about we develop "pods" of doctors and medical health professional built specifically around different 'sets" of healthcare consumers.
Each pod would have, for instance GP's, and specialists, Nurse Practitioners, etc chosen for specific areas of practice. You could have a pod chosen for family care - with Ob/Gyn's, Obstetricians, Child Development specialists, etc as well as GP's and an association with a General Care pod for the parents.
The General care pod would be just that - basic GP and specialist care.
The young could elect a Sports Medicine pod with specialists in sports injuries, physical therapy, etc - many would elect coverage to get in on this.
Chronic Disease pods where specialists in say cancer or diabetes could work together.
Mental Health pods with access to those specialists along with medical specialists trained in mental heaths effects on the body and vice versa
And of course Geriatric pods.
All the doctors in a pod would talk - in person or Skype - about the patients in the pod they were seeing in common - coordinating your care.
Of course it works better in large cities, but rural pod members could arrange days to be in towns, or transportation to their offices - it's at least as good as the system they have now.
Everybody would pay a monthly fee to the pod of choice - minimum for the basic general care on up - the fee subsidized according to your income - from nothing to full freight.
Nobody in Congress has any ideas - here's one.
Each pod would have, for instance GP's, and specialists, Nurse Practitioners, etc chosen for specific areas of practice. You could have a pod chosen for family care - with Ob/Gyn's, Obstetricians, Child Development specialists, etc as well as GP's and an association with a General Care pod for the parents.
The General care pod would be just that - basic GP and specialist care.
The young could elect a Sports Medicine pod with specialists in sports injuries, physical therapy, etc - many would elect coverage to get in on this.
Chronic Disease pods where specialists in say cancer or diabetes could work together.
Mental Health pods with access to those specialists along with medical specialists trained in mental heaths effects on the body and vice versa
And of course Geriatric pods.
All the doctors in a pod would talk - in person or Skype - about the patients in the pod they were seeing in common - coordinating your care.
Of course it works better in large cities, but rural pod members could arrange days to be in towns, or transportation to their offices - it's at least as good as the system they have now.
Everybody would pay a monthly fee to the pod of choice - minimum for the basic general care on up - the fee subsidized according to your income - from nothing to full freight.
Nobody in Congress has any ideas - here's one.
2
The Senate and House proposed bills cannot be rescued. They are cruel, mean-spirited and based on an illusion, i.e., that market forces (competition) will reduce costs, etc. Anyone who thinks that either of these proposed bills can be fixed are also living in an illusionary world.
2
Why do people "hate the mandate"? We are mandated to educate our children because it's good for all. If all had health care, all could work and be productive and better support themselves and their families. Society pays dearly for folks without insurance. A young friend of mine was proud that she is healthy and doesn't NEED health insurance. But, if she has an accident, the paramedics roll, the ambulance delivers, and the ER treats. We ALL pay for her lack of health care. In the same vein, untreated high blood pressure only gets worse and we ALL pay for that visit to the ER, subsequent treatment and support for the person who now cannot work. To me, it's all basic. Healthcare for all is sound moral and economic policy.
16
But where is the tax cut for those who don't even need one, the 1%?
1
Yes, the majority of us pay for the uninsured in taxes and higher insurance premiums. Hospitals, just like other businesses, charge higher prices to offset some of their losses in uncompensated care. That in turn leads insurance companies to charge higher premiums. If you are employed and your employer pay some or all of your monthly premium that is factored into their cost of doing business and they pass those cost on to anyone that buys their service or product. Medicare, Medicaid, public programs, private insurance , etc...none of them reimburse a hospital a 100% of billed charges and all of us (some more some less) pick up the tab as I outlined above. There ain't not free lunch and many of us are eating a cheese sandwich instead of a steak and baked potato. Whether you lean Left, Right or some where in between, healthcare for everyone is in the interest of common good, a sound moral and economic policy for America as Dianne writes.
2
You are absolutely correct that the individual mandate makes sense! There is no free ride when it comes to healthcare. These same Reps would have you believe next that SS and Medicare should be voluntary.
1
Oh my goodness! Where to start? How about with the tax relief Douthat wants to give the manufacturers of medical devices and prescription drugs? Does anyone believe that the pricing would drop for consumers? Isn't our experience with modern 'business' that prices remain the same or go up with the 'savings' being diverted to executives pay? Or more cruelly, the savings go to mechanizing the factories and sending the unemployed workers to West Virginia to take part in the fake renaissance in mining. Does anyone believe that eliminating the mandate will help 'middle-class consumers'? Isn't our experience that the 'middle class' is shrinking and no longer means what it dis when Douthat learned how to balance a checkbook in college? And, most important, does anyone - I repeat - anyone think that the GOP can pass health care legislation without transferring money to its 'handlers'? The GOP has no interest in helping Americans unless they define help as redistributing national wealth to those who already have vastly more of their share of the money.
11
If your a Democrat, or even a Bernie Sanders supporter, my take is, both the media and the Democratic political elite understand things will get back to normal , like Obama Care, when Trump and his administration get thrown out of office in some sort of a landslide, come the next election. Americans overwhelmingly want Universal Healthcare. Something, much like comprehensive tax reform, that is simply beyond our lawmakers capabilities.
5
Under right leaning Supreme Court, and soon to be Federal Court system, Republican gerrymandering and voter suppression it will take 20 years for things to be "right". I don't think we have the time. Sad, hugely sad for this country.
I have never understood why universal health care has not been pitched as one of the most business friendly ways of dealing with health care available (well, Warren Buffet has pointed out that the burden of health care is much more onerous to business than taxes). Why is health care the responsibility of employers? Think of how much money they could save if they did not have to hire whole staffs in many cases just to keep up with their employees' health insurance needs?
When we say we want new start-ups and innovation and entrepreneurship, portable health care would make leaving safe employment to create new businesses much less risky (David Brooks has pointed this out in general in terms of safety net programs). In terms of freedom, what would be more freeing than to know that leaving a place of employment to change jobs or start a company that creates new ones does not mean either not being able to find health care or to afford it?
But this is where we are now: thinking small and smaller all the time.
When we say we want new start-ups and innovation and entrepreneurship, portable health care would make leaving safe employment to create new businesses much less risky (David Brooks has pointed this out in general in terms of safety net programs). In terms of freedom, what would be more freeing than to know that leaving a place of employment to change jobs or start a company that creates new ones does not mean either not being able to find health care or to afford it?
But this is where we are now: thinking small and smaller all the time.
15
Yes...but, Universal Healthcare is being cast as heresy. The economic oligarchy has aggressively promoted and distributed what are now unquestioned, deeply held economic religious beliefs. These include the myths of unregulated "Free Markets", "The Invisible Hand" and "Trickle Down Edonomics". And, of course "Emergence" -- the broad prosperity that, as it is preached, miraculously emerges from unbridled individual greed. If you truly believe well enough, this all creates a "Rising Tide That Lifts All Boats".
This is the second op-ed recently that talks about parts of the bill that may be reasonable and even possibly an improvement from the ACA. Removing the tax on medical devices and medicine makes since. . Those taxes certainly aren't contributing to an affordable health care goal. But it won't pass because too many will refuse to allow a cut in Medicaid. There may be some problems but work to reduce them and keep the program. Medicaid serves the neediest and it works. If anything,it should be expanded. One of the main problem with the bill is that Mitch has turned veto power over to characters like Paul and Cruz. Cruz was a candidate who promised to end Obama care on day one of his presidency, He was also going to solve the Syrian problem by carpet bombing them. But if McConnell marginalized them and followed advice by such as Susan Collins, he might get some help from the other side of the aisle. Of course he would have to reduce the tax break for the wealthy. People won't remember all the criticism if a good bill is passed and even more
so if some names on the passage come from the Democrats. The best results is to serve the people rather than ideology
so if some names on the passage come from the Democrats. The best results is to serve the people rather than ideology
1
From your description, people would sign up for medical insurance in the ambulance on the way to the hospital, then cancel their policy as soon as they were better. You estimate of how much it would cost to cover people is low by large factors. People will not carry coverage if they can sign up for it the minute they need it and cancel it immediately.
5
There's a two-month waiting period in what he proposes if you don't maintain "continuous" coverage (an insurance industry concept that should be confined to the lower rungs of hell).
So if you're coughing up blood, just wait two months for surgery to remove the tumor by which time it's spread all over your body, then buy the insurance, have the medical industry move in and perform all sorts of last ditch efforts to keep your body alive for 3 more torturous years, then succumb to an inevitable death.
And everyone else who lived responsibly and bought insurance coverage for themselves and their families, because, well, you never know...will watch their premiums rise and rise and rise because someone else just hated that nasty old mandate that they should live responsibly too.
So if you're coughing up blood, just wait two months for surgery to remove the tumor by which time it's spread all over your body, then buy the insurance, have the medical industry move in and perform all sorts of last ditch efforts to keep your body alive for 3 more torturous years, then succumb to an inevitable death.
And everyone else who lived responsibly and bought insurance coverage for themselves and their families, because, well, you never know...will watch their premiums rise and rise and rise because someone else just hated that nasty old mandate that they should live responsibly too.
A noble effort, Mr. Douthat, but I doubt it could be so simple, given the myriad viewpoints on healthcare coverage. Your plan would have to be amended and amended to get it through. It seems to me universal care and universal taxes are where we are headed, and the only real solution to this complex situation. Getting the useless insurers out of the picture and funding the program adequately with fair taxes is far better than tweak upon tweak.
9
Hmmm. I pay $1600/mo for a family plan. Eliminate the 'mandate' and reduce subsidies... how many healthy people will drop out of coverage and how much more will I pay per month?
Before Douthat proposes changes it would be good to run economic analyses. In fact, before the Senate proposes changes, it would be good too.
Before Douthat proposes changes it would be good to run economic analyses. In fact, before the Senate proposes changes, it would be good too.
11
Big error in the fourth paragraph:
"The Democratic bill in 2010 delivered significantly to the party’s base; the Republican bill in 2017 delivers significantly only to the party’s donors. "
Actually, some of the most significant benefits have gone to the republican people of Kentucky, West Virginia, etc. So your sentence should have read:
"The Democratic bill in 2010 delivered significantly to all Americans, including significant numbers of future Trump voters; the Republican bill in 2017 delivers significantly only to the party’s donors."
"The Democratic bill in 2010 delivered significantly to the party’s base; the Republican bill in 2017 delivers significantly only to the party’s donors. "
Actually, some of the most significant benefits have gone to the republican people of Kentucky, West Virginia, etc. So your sentence should have read:
"The Democratic bill in 2010 delivered significantly to all Americans, including significant numbers of future Trump voters; the Republican bill in 2017 delivers significantly only to the party’s donors."
30
And the vast majority in KY and WVa would remain on Medicaid with the rep plan. Hillbillies live below poverty line. Check facts.
Going small on everything. It's easier to run a demolition derby than build a car from scratch. Fact is the Republicans can't even agree on what they're against let alone come together with each other and/or the Dems to craft legislation that works for the majority and lasts. Funnily enough, the Trump devotees are actually for big government benefits – but only for people who look like them. Small minds for small healthcare.
10
Sorry, Sir but totally and UTTERLY WRONG!
First, the smaller bill would repeal the individual mandate requiring the purchase of health insurance. It would replace it, as the Senate bill does, with a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months.
The hated mandate produces immediate pain at tax time thereby nudging folks to purchase insurance, a future, only possible waiting time will be less effective. A waiting period to purchase insurance will cause families to go bankrupt because many or most illnesses do not offer a choice of when to be treated and incur costs. I didn't think it possible, but this actually is a far worse solution to how to get people to maintain their insurance.
The rest of these ideas are just tweaking an already over complicated morass, cobbled to avoid the obvious effective solution, single payer. The screams you hear in the background are not from early fireworks, they are from the insurance industry who have made careers siphoning off money from $ spent on health care.
First, the smaller bill would repeal the individual mandate requiring the purchase of health insurance. It would replace it, as the Senate bill does, with a continuous-coverage requirement — a waiting period to purchase insurance if you go without it for more than two months.
The hated mandate produces immediate pain at tax time thereby nudging folks to purchase insurance, a future, only possible waiting time will be less effective. A waiting period to purchase insurance will cause families to go bankrupt because many or most illnesses do not offer a choice of when to be treated and incur costs. I didn't think it possible, but this actually is a far worse solution to how to get people to maintain their insurance.
The rest of these ideas are just tweaking an already over complicated morass, cobbled to avoid the obvious effective solution, single payer. The screams you hear in the background are not from early fireworks, they are from the insurance industry who have made careers siphoning off money from $ spent on health care.
15
I have wondered why the we never see projections as to what the federal budget in total would look like if nothing is done to control healthcare spending over the next 20 years. We can always find individual people's stories to support expansion of coverage but really don't see the impact that spending has on our overall society. Is money an unlimited commodity? Will we have less money to spend on education or the environment if we have an unlimited healthcare budget?
We spend 60% of the individuals lifetime healthcare dollars in the last 30 days of their lives. There has to be a better way.
Where are Simpson & Bowles?
We spend 60% of the individuals lifetime healthcare dollars in the last 30 days of their lives. There has to be a better way.
Where are Simpson & Bowles?
1
We are already spending as little as possible on education and the environment under the current crop of do-nothings. Maybe there would be less to spend on our bloated military and war weapons. The very thought is enough to break a general's heart.
So how many people are going to lose coverage under Douhat's "solution" one wonders? At bottom Obamacare increased taxes on the wealthy and followed actuarial logic in imposing the mandate in order to expand coverage and provide other benefits like community pricing and guaranteed issue. Reduce or take those elements away and coverage will fall. There is nothing magic about all this. Of the roughly 300 million adults and children who are currently covered by different types of insurance all but about 10 million of them receive subsidies of one sort and another (yes employer/employee tax breaks on employer provided coverage are subsidies as is the mortgage deduction) so how hard is it to understand the connection. Douhat of course ignores the real reason for the Republican effort to gut (not reform) Obamacare and Medicaid. It's to provide huge tax cuts for their wealthy donor base and everyone with an IQ above room temperature knows it.
18
Well stated.
"...Republicans in 2017 can't agree on what their health care policy goal goal should be."
No, Ross, none of them has anything resembling a health care policy, unless that policy is "don't have care" (we'll set aside that we're talking mostly about "coverage" - how we finance health treatment - than actual "care"; lots of people who aren't good at thinking about or discussing health policy make this same amateur mistake).
What they DO have, first and of course foremost, is a tax cuts policy - which in essence is, "let's distribute money upward to the very, very, very wealthiest few of us". And their rancid priorities of course make devising acceptable public policy practically impossible - even with your ardent defenses of their scurrilous scheming.
No, Ross, none of them has anything resembling a health care policy, unless that policy is "don't have care" (we'll set aside that we're talking mostly about "coverage" - how we finance health treatment - than actual "care"; lots of people who aren't good at thinking about or discussing health policy make this same amateur mistake).
What they DO have, first and of course foremost, is a tax cuts policy - which in essence is, "let's distribute money upward to the very, very, very wealthiest few of us". And their rancid priorities of course make devising acceptable public policy practically impossible - even with your ardent defenses of their scurrilous scheming.
14
Interesting that Douthat, like most Republicans, is focused on how to achieve legislative success even if that success translate to pain and suffering on the part of the Republican blue collar constituency.
13
Clearly you do not understand the current job market. Many people, especially those in their 50s are laid off, mostly so employers can pay someone younger less. How do you propose a 50 year old find a job in 2 months?
21
Mr. Douthat errs when he says that a two-month insurance lapse would keep those who want to be in the market, well, in the market. He's largely speaking of, first, the healthy population insurers need to keep costs down, and second, a young population, largely those in their twenties who have just come off their parents' or colleges' policies and whose lives are centered on finding jobs, finding mates, finding homes or apartments, going to grad school or entering the military. Health insurance is the last thing on their minds. Many previous generations never had to worry about such matters at this age - many more jobs were full time and employers believed in good benefits or unions prodded them to provide them. So In-between graduating, starting work, getting married, moving and just being young and a little crazy, young middle class people would lose insurance and would get sick and maybe even die just because, well, they were busy.
6
Ross states that the passing of the ACA delivered to the Democratic base. That is a typical example of ideological myopia.
What the Republucans are being forced to confront is that the ACA delivered considerable benefit to the Republican base as well, most notably with the Medicaid expansion. The few red state governors who accepted the expansion understand that - hence their objections to the proposed bill.
The ACA, flawed as it is, had a laudable policy objective - to make health insurance available to more Americans and to improve the level of care that insurance provided.
The Republicans' goal is simply to take as much of that away as possible and pass on the financial savings to the wealthiest Americans - who already need not worry about their access to health care.
Any wonder they are facing trouble?
What the Republucans are being forced to confront is that the ACA delivered considerable benefit to the Republican base as well, most notably with the Medicaid expansion. The few red state governors who accepted the expansion understand that - hence their objections to the proposed bill.
The ACA, flawed as it is, had a laudable policy objective - to make health insurance available to more Americans and to improve the level of care that insurance provided.
The Republicans' goal is simply to take as much of that away as possible and pass on the financial savings to the wealthiest Americans - who already need not worry about their access to health care.
Any wonder they are facing trouble?
37
Trump will sign whatever health care "reform" emerges from Congress. His surface-only understanding of the complexities of the issue (Who knew it would be so hard?) render him incapable of doing anything but going along. Something "great" will emerge from all this? The only "great" thing on the horizon is the great disappointment of millions of people who will find that they can no longer afford a health insurance policy that provides less coverage at a higher price. Interesting to note that Douthat doesn't mention the CBO's conclusion that 23 million of our citizens will move from the ranks of the insured to the uninsured......
9
How is it possible that WE THE TAX PAYERS are forced to pay for these republicans lawmakers (and their families) PREMIUM health care FOR LIFE...and yet THEY get to decide IF WE EVEN HAVE ANY???
Why isn't that the ONLY talking point moving forward with their debate?
Why isn't that the ONLY talking point moving forward with their debate?
43
Now that you've figured out how to engineer a political win for the right how do you propose a win for the people in terms of medical care?
29
Why do we keep going round on this merry go round? Unless and until you get rid of the profit motive in the health care system, yo will continue to see rising prices and a strain on the nation, all in the midst of a system that works wonderfully...it's called Medicare.
We continue to thrash around and the conservatives continue to say it will doom us, but the fact is that it improved the QUALITY of health care for seniors and that is what it should be about, not whose ox is being gored. We have the means to do it, all we need is the will and when we do, we will climb out of 37th place on the quality of care scale that is a monitor on world health.
We continue to thrash around and the conservatives continue to say it will doom us, but the fact is that it improved the QUALITY of health care for seniors and that is what it should be about, not whose ox is being gored. We have the means to do it, all we need is the will and when we do, we will climb out of 37th place on the quality of care scale that is a monitor on world health.
26
Instead of capping Medicaid, why not tax doctor's and hospital's fees? That is where the problem lies. There is no real market for competition to lower fees because most consumers never see them or pay them directly, and there is no real insurance market either so insurers are not motivated to negotiate aggressively. For a start, there should be an online resource where consumers can transparently compare doctor and hospital prices and performance ratings.
Doctors in other countries make much less than in the U.S. My cousin in Europe is a physician and makes a comfortable but middle class salary, and that is typical. Those costs are a big contributor to the high U.S. health care costs.
Doctors in other countries make much less than in the U.S. My cousin in Europe is a physician and makes a comfortable but middle class salary, and that is typical. Those costs are a big contributor to the high U.S. health care costs.
10
The simple truth is that we won't see the kind of health care reform that we all need and want i.e. Universal Single Payer Medicare for All, until the Republicans are shown the exit door and we elect politicians who actually don't regard compassion and empathy as dangerous or forbidden concepts, but actually embrace the opportunity to improve the lot of their fellow citizens.
SUMMARY: Repeal and Replace Stone Age Republicans!
SUMMARY: Repeal and Replace Stone Age Republicans!
30
How is it possible that WE THE TAX PAYERS are forced to pay for these republican lawmakers (and their families) PREMIUM health care FOR LIFE...and yet THEY get to decide IF WE EVEN HAVE ANY???
Why isn't that the ONLY talking point moving forward with this healthcare debate?
Why isn't that the ONLY talking point moving forward with this healthcare debate?
4
The GOP error is in using budget reconciliation process to force through important legislation without the input and voting of all 100 members of the Senate in a craven attempt to keep our elected senators from having to actually work with the loyal opposition party to acheive needed reforms to the ACA.
7
Ross: doing without the individual mandate and replacing it with a continuous coverage requirement won't do the trick. Young Americans will simply forgo buying insurance while their years of low risk pass by. Upon finally reaching an age when they face the increased probability of a need for insurance, they will buy it. There will be no penalty for non-continuous coverage because they will not have had coverage before. Result: the loss of millions of dollars needed for a fully functioning health care plan for all Americans.
14
Ross misses a key point - the individual health insurance market has been ravaged by Obamacare and if you don't take steps to fix it none of this matters. Allowing a federal charter for health insurers so they can sell across state lines is key to getting insurance company options back in rural America along with allowing a full set of policy options, such as health savings accounts.
6
Chris misses a key point - the individual health insurance market has never been great, but has been improved by Obamacare.
4
That assumes that insurance companies want to operate across state lines to service rural areas. Setting up a network of providers (doctors, medical professionals, hospitals and other facilities) in rural areas is much more difficult than it is in urban/metropolitan centers where these assets are in abundance.
2
We've spent billions upon billions subsidizing people and insurers to add 2.3 million to the rolls in the individual market? And we made coverage for the individuals that aren't subsidized unaffordable. We've driven insurers out of rural counties across the country. That's success?
Ross is simply trying to get Medicaid capped. A per-capita cap on a program that already pays too *little* per person will only further damage Medicaid, which, remember, is how nursing home care, home care for the elderly, and care for the disabled, as well as the more well-known funding for low and middle income people.
And for the next few decades, health needs per capita are going to increase, as the population ages.
In other words, Douthat simply proposes a big cut in Medicaid benefits combined with the Republican standby of more tax cuts for the wealthy.
Surprise, surprise, surprise.
And for the next few decades, health needs per capita are going to increase, as the population ages.
In other words, Douthat simply proposes a big cut in Medicaid benefits combined with the Republican standby of more tax cuts for the wealthy.
Surprise, surprise, surprise.
12
The Trump administration made a huge mistake in taking up the Trump promise (during the campaign) of repealing and replacing Obamacare. It would have been wiser to initially take up tax-reform, which could have been designed specifically for the Middle Class and might have received bipartisan support. The Obama desire to expand Medicaid as part of the ACA was met with opposition by many conservative states, since it likely would have bankrupted many states. The truth is that healthcare costs much more as a percentage of GDP than in other developed countries. It has been particularly difficult to promote free-market competition to lower doctors and hospital fees, given the entrenched system now in effect.
2
The GOP is confused and divided on health care because in order to tackle the details and improve the law we have today, you need the passion to do something better for all the American people.
The GOP has demonstrated all that passion only for improving the financial well-being of the very rich through tax cuts and by eliminating regulations that protect the public from the providers of goods and services that might not have the consumer's best interest in mind.
Maybe if the Senators and Representatives would voluntarily give up the health insurance that their jobs provide and buy their own in the market like all individuals that do, they will be very successful convincing the American people, including myself, of their good faith.
However, I think that these elected officials are not legislating with the interest of all at heart. If they would give up their government heath coverage, the Bill would look a lot different.
The GOP has demonstrated all that passion only for improving the financial well-being of the very rich through tax cuts and by eliminating regulations that protect the public from the providers of goods and services that might not have the consumer's best interest in mind.
Maybe if the Senators and Representatives would voluntarily give up the health insurance that their jobs provide and buy their own in the market like all individuals that do, they will be very successful convincing the American people, including myself, of their good faith.
However, I think that these elected officials are not legislating with the interest of all at heart. If they would give up their government heath coverage, the Bill would look a lot different.
8
What kind of country and legislators do you have, when they can't take care of the poorest and weakest of all Americans? You have the money for a 700 billion military, the money to pay the legislators who will cut your health care, and the money to pay a superb health plan for the same legislators.
Let the Congress and Senate also make cuts to their health care system, as they cut the health care for the public. What's good for the gander, is also good for the goose. And believe me, you Americans are being "goosed", especially from trump-small "t"!
Let the Congress and Senate also make cuts to their health care system, as they cut the health care for the public. What's good for the gander, is also good for the goose. And believe me, you Americans are being "goosed", especially from trump-small "t"!
18
A better proposal than the Republicans have so far offered but it fails on the one essential goal of previous Republican proposals: a huge tax break for millionaires and billionaires paid for by eliminating the healthcare insurance of millions of ordinary Americans.
I suspect that the Republicans would rather let the system crash than abandoned that goal.
I suspect that the Republicans would rather let the system crash than abandoned that goal.
11
Mr. Douthat in one sentence suggests that the Republicans in 2017 can’t agree on what their health care policy goal should be... yet in the very next sentence he identifies one area of agreement when he writes: "...the Republican bill in 2017 delivers significantly only to the party’s donors." Unless the party donors pony up more revenue even Mr. Douthat's smaller bill is impossible.
6
i would like Mr Douthat to explain how repealing a mandate to have insurance is fair or just when that uninsured person, who will almost inevitably require medical care at some point, then becomes my responsibility. Hospitals and many doctors still must and will care for anyone, insured or not and pass that cost onto those of us who are insured, through higher prices and higher premiums.
While your at it, explain the need to repeal taxes on medical devices and pharmaceuticals when those industries are posting record profits even when taxed?
Finally, explain why Medicare for all would not be the best option for the wealthiest nation on earth in terms of justice, equity and efficiency?
While your at it, explain the need to repeal taxes on medical devices and pharmaceuticals when those industries are posting record profits even when taxed?
Finally, explain why Medicare for all would not be the best option for the wealthiest nation on earth in terms of justice, equity and efficiency?
94
exactly!!! One of the reasons for the creation of a national health care plan was to lower the exorbitant cost to us (the taxpayer) of health care delivered in the emergency room because people have no doctor and no insurance.
5
Having lived through multiple serious illnesses, and thus dealt with expensive medical procedures, I am amazed that my health insurance company is in business at all. They permit doctors to submit outrageous bills, everyone knowing that they will be paid only a fraction. They randomly reject bills, only to reverse that decision at a later date. All these billing procedures appear to be a sham just to drive up the real costs and while creating the appearance of saving me money. Where is the value added in all this?
Why does my employer, who picks these expensive plans for me, permit this? Why do we raise prices on our products to pay for this useless service? Wouldn't America be Greater if this layer of bureaucracy were eliminated, so our exports could better compete in the world marketplace? Single payer is the way forward, for businesses, and for the people.
Why does my employer, who picks these expensive plans for me, permit this? Why do we raise prices on our products to pay for this useless service? Wouldn't America be Greater if this layer of bureaucracy were eliminated, so our exports could better compete in the world marketplace? Single payer is the way forward, for businesses, and for the people.
52
I second this remark. After my wife died of cancer in 2004, I wanted to spend time with our young sons (aged 11 and 13 years) to rebuild as much as I could of their damaged lives. Instead I devoted a lot of time to resubmitting bills that the insurance company had rejected for no reason at all. They paid the second time around ... they didn't make that first rejection to save money, they made it toy with me (and with my children).
1
All the while transferring money out of the healthcare equation to shareholders as profit.
Medicare for All!
Medicare for All!
1
We need a better understanding of where all the health care funds are going. My guess is that 80% of the spending is unnecessary, i.e, administrative, a result of improper living, cheating, insurance against lawsuits, etc. And we should remember that the chief cause of rising health care cost is health insurance itself. It is a huge moral hazard.
6
Or, they could do the smartest thing of all: Pass Medicare for All legislation that covers everyone and eliminates the middleman insurance industry responsible for the outrageous cost of healthcare in America vs every other developed country. It would cost less, deliver far better quality of care and end the disparity of 50 state budget busting approaches to health insurance. This could be a "Nixon to China" moment. If Republicans gave Americans Medicare for All they would be in power for generations. Not to worry Democrats, they'll never do it.
80
Every other developed country insists that all citizens are covered - and pay in if they have an income.
It was always a conservative idea based on personal responsibility that individuals do not burden the rest of us by showing up seriously ill for lack of preventive care and unable to pay for emergency surgery, or go bankrupt doing so.
We will never see improvements in health or lowering of costs if we allow 20% of people to remain uninsured (we were approaching that number before the ACA reversed the trend).
Country after country that spend 40-60% less than we do with higher patient satisfaction and better results prove that and the opposition of Republicans to an idea they came up with and implemented with good results in MA is nothing more than anti-Obamaism and an aspect of the ACA that was easily attacked in sound bites.
It was always a conservative idea based on personal responsibility that individuals do not burden the rest of us by showing up seriously ill for lack of preventive care and unable to pay for emergency surgery, or go bankrupt doing so.
We will never see improvements in health or lowering of costs if we allow 20% of people to remain uninsured (we were approaching that number before the ACA reversed the trend).
Country after country that spend 40-60% less than we do with higher patient satisfaction and better results prove that and the opposition of Republicans to an idea they came up with and implemented with good results in MA is nothing more than anti-Obamaism and an aspect of the ACA that was easily attacked in sound bites.
32
Much of the arguments regarding how to insure Americans are rooted in parochialism. Americans approach medical insurance as if new solutions are required when, in fact, national systems already exist that are far less costly and are superior in results.
For example, the French system, a mixture of government and private insurance, is rated by the WHO as providing one of the best if not the best in health outcomes while costing half, on average, of what it costs Americans. That same WHO study found the US ranked at 37th in overall health system performance.
Instead of again trying to reinvent the wheel why not simply apply proven medical coverage systems? The mechanics of doing so would be far simpler than what the Democrats or Republicans have put together or proposed and it would have the benefit of being a demonstrated, proven product. So what's the problem?
The problem, of course, is that the medical profession, hospitals, medical equipment providers, and pharmaceuticals would have their incomes scaled back .... and that's not going to happen, not easily at least.
So, on this Fourth of July be careful celebrating or you may end up in the most costly medical facilities in the world that performs at levels slightly better than Slovenia and far worse than Morocco.
For example, the French system, a mixture of government and private insurance, is rated by the WHO as providing one of the best if not the best in health outcomes while costing half, on average, of what it costs Americans. That same WHO study found the US ranked at 37th in overall health system performance.
Instead of again trying to reinvent the wheel why not simply apply proven medical coverage systems? The mechanics of doing so would be far simpler than what the Democrats or Republicans have put together or proposed and it would have the benefit of being a demonstrated, proven product. So what's the problem?
The problem, of course, is that the medical profession, hospitals, medical equipment providers, and pharmaceuticals would have their incomes scaled back .... and that's not going to happen, not easily at least.
So, on this Fourth of July be careful celebrating or you may end up in the most costly medical facilities in the world that performs at levels slightly better than Slovenia and far worse than Morocco.
32
"The problem, of course, is that the medical profession, hospitals, medical equipment providers, and pharmaceuticals would have their incomes scaled back .... and that's not going to happen, not easily at least."
Right. And Republicans could care less about controlling these groups' incomes, and I do believe that you left out the insurance companies in your list. The Democratic politicians are also supported by these powerful groups' political contributions. At least the Democrats admirably tried to put in a system that controlled the profits of the health care industry and tried to cover everyone.
But costs are overwhelmingly health care - from Medicaid to Medicare to Employer sponsored health care. Single payer solves nothing unless health care costs are reduced and to reduce them both Democrat and Republican politicians would need to undercut the excess profits of their sponsors. I guess we all see the problem...
The system can not handle health care for all -- single payer or otherwise -- without curtailing somewhat the incomes of all the groups involved in the health care industry. And how will that happen? Unfortunately, I really don't see it.
Right. And Republicans could care less about controlling these groups' incomes, and I do believe that you left out the insurance companies in your list. The Democratic politicians are also supported by these powerful groups' political contributions. At least the Democrats admirably tried to put in a system that controlled the profits of the health care industry and tried to cover everyone.
But costs are overwhelmingly health care - from Medicaid to Medicare to Employer sponsored health care. Single payer solves nothing unless health care costs are reduced and to reduce them both Democrat and Republican politicians would need to undercut the excess profits of their sponsors. I guess we all see the problem...
The system can not handle health care for all -- single payer or otherwise -- without curtailing somewhat the incomes of all the groups involved in the health care industry. And how will that happen? Unfortunately, I really don't see it.
2
@john in Fla. : "And how will that happen?" Single payer doesn't mean"single provider". Health care providers - -doctors, hospitals, ambulances - all sell to one buyer who knows all the costs and has a political responsibility to provide care to everybody. The single payer must provide care to everybody, and to do that, it has to pay enough to keep the providers in business. But not more. Single payer is the best way to drive down costs. Ask Norway, Canada and any number of other countries where it works. The Tom Price's, Alexander Lamar's and Rand Paul's won't like it - but what will they do? Resign their place in the swamp and move to El Salvador, maybe, where they can ply their trade at the price the market will bear.
Classifying Rahm Emmanuel's 2008 endorsement of a Medicaid expansion as "going timid" appears to be case of hysterical blindness in the face of a massive constitutional change. In fact, that issue lies at the heart of the current dilemma within the GOP.
During the years that have passed, the left has solidly endorsed the idea of a fundamental right to basic health care. Whether or not private insurance companies play a role is the secondary question. The right has not evolved during that period of time, and remains riven by fundamental disputes that could threaten the GOP's hold on congress.
Since the congressional leadership needs to protect GOP seats that reflect the full spectrum of rightist views, they would appear to be safest by continuing to crank their legislative meat-grinder for at least another year. No matter what type of bill is produced, or even if not produced, the 2018 midterms would become a decentralized GOP referendum on whether or not the effort to correct the flaws of ACA should continue, while blaming the inaction on the other party's "needless" polemic on civil rights.
During the years that have passed, the left has solidly endorsed the idea of a fundamental right to basic health care. Whether or not private insurance companies play a role is the secondary question. The right has not evolved during that period of time, and remains riven by fundamental disputes that could threaten the GOP's hold on congress.
Since the congressional leadership needs to protect GOP seats that reflect the full spectrum of rightist views, they would appear to be safest by continuing to crank their legislative meat-grinder for at least another year. No matter what type of bill is produced, or even if not produced, the 2018 midterms would become a decentralized GOP referendum on whether or not the effort to correct the flaws of ACA should continue, while blaming the inaction on the other party's "needless" polemic on civil rights.
6
Kind of interesting that Douthat's piece on health care doesn't mention either 'health' or 'care', only budget numbers to make his Republican people, who have health insurance, happy. This, like everyone other Republican plan, is to deny stable health care access to anyone not like them. There is no discussion of required coverages, pre-existing conditions, confidence is gaining treatment, etc. Only worry about budget costs and taxes.
A little attention to the actual outcomes would be interesting and valuable. Douthat, like his legislative counterparts, shows no interest in the human cost of bad health, or the economic cost of people who cannot work and claim treatment through mandated care in Emergency Rooms.
This is like most of the Republican thinking on health care pretty mean spirited and short sighted.
A little attention to the actual outcomes would be interesting and valuable. Douthat, like his legislative counterparts, shows no interest in the human cost of bad health, or the economic cost of people who cannot work and claim treatment through mandated care in Emergency Rooms.
This is like most of the Republican thinking on health care pretty mean spirited and short sighted.
45
Mr. Douthat most likely doesn't know anyone who benefits from Medicaid. The need for Medicaid won't stop with the cut in funding. Douthat isn't any less cruel than the Congressional Republicans who have produced this awful, thoughtless, cruel so-called "Better Care " bill which is chiefly a tax cut for those who don't need it.
The dream of the right wing wonks like Paul Ryan and Tom Price is to end the ACA, Medicaid and Medicare once and for all....and that is NOT what Trump voters supported. Trump ran on better health insurance at an affordable price. A large majority of Americans want the government to have these health insurance programs. They don't want to drown the government in the bathtub.
Ryan, Price and McConnell thought this was their moment to take advantage of the GOP control of Congress and the White House, to do something that only a tiny fraction of America supports. They should have expected the backlash. There are still 29 million Americans who do not have employer coverage and who cannot afford the ACA monthly premiums and deductibles. While these changes may keep the subsidized participants on the rolls, and those who can find the money to pay those high premiums (very few, around 3 million people), it will leave the Trump voters who believed they would get decent health insurance at an affordable price out in the cold. They'll see this as a broken promise.
Ryan, Price and McConnell thought this was their moment to take advantage of the GOP control of Congress and the White House, to do something that only a tiny fraction of America supports. They should have expected the backlash. There are still 29 million Americans who do not have employer coverage and who cannot afford the ACA monthly premiums and deductibles. While these changes may keep the subsidized participants on the rolls, and those who can find the money to pay those high premiums (very few, around 3 million people), it will leave the Trump voters who believed they would get decent health insurance at an affordable price out in the cold. They'll see this as a broken promise.
17
The Republican plan may not be what Trump supporters wanted, but are you really sure what Trump wants? He has gone from a position of saying that there should be no cuts in Medicare, Medicaid and Social Security to one in which he once supported the draconian House bill to support for the even worse Senate bill to his latest position which is kill Obamacare and do a Republican plan later. The truth is this man has no concern about the healthcare of others, he just wants a bill that he can sign. Your last statement: "They'll see this as a broken promise" is doubtful. His base seems to stick with him from one lie to the next; from one broken promise to the next.
2
What are the real cost drivers of medical care? For starters a population that doesn't do a lot to take care of themselves. Nearly half the population has barely enough income to survive working multiple jobs so where is the time to do self care, and where is the money to buy the necessities to assure a healthy diet?
What about the medical care market that uses, but never publishes, their charge master (what the bill for each procedure). How does a medical consumer make a decision on a provider. Insurance companies don't publish their payment schedule and what they will not cover and what the individual liability will be.
Then there are the hospitals that generally provide the space but all of the services are contracted out to private businesses that often don't have contracts with any medical insurance company. The hospital may have a contract with an insurance provider but the doctors and nurses may not.
The medical care business is a black-box that few of us understand but all of us have to deal with.
Simplistic solutions will never work. In the meantime Americans who aren't part of the topmost income brackets have the worst medical outcomes of any industrialized nation on the planet.
What about the medical care market that uses, but never publishes, their charge master (what the bill for each procedure). How does a medical consumer make a decision on a provider. Insurance companies don't publish their payment schedule and what they will not cover and what the individual liability will be.
Then there are the hospitals that generally provide the space but all of the services are contracted out to private businesses that often don't have contracts with any medical insurance company. The hospital may have a contract with an insurance provider but the doctors and nurses may not.
The medical care business is a black-box that few of us understand but all of us have to deal with.
Simplistic solutions will never work. In the meantime Americans who aren't part of the topmost income brackets have the worst medical outcomes of any industrialized nation on the planet.
29
I have a question,for my Republican friends. When in,the history of Health insurance has the cost of insurance EVER gone down? And without the tax on medical equipment can we be assured that those savings will be passed on to the consumer?
The concept of having a free marketplace fails to understand the relationship between doctors and patient. I trust the doctor when he suggest a certain procedures is done. I don't want to shop around for a doctor I don't know and trust.
The concept of having a free marketplace fails to understand the relationship between doctors and patient. I trust the doctor when he suggest a certain procedures is done. I don't want to shop around for a doctor I don't know and trust.
26
Another question for our Republican friends: Since you believe the free market is a major part of the answer to our healthcare problem, why didn't the market lower the costs of health insurance before Obamacare to take care of at least some of the millions of uninsured? The answer, which Republicans refuse to acknowledge, is that the market doesn't work in situations like healthcare. Sure you can do some things that increase competition like the ever-present suggestion from Republicans of selling policies across state lines, but none of their suggestions even begin to address the enormous commitment necessary to provide healthcare for all our citizens. There is not a single universal healthcare plan in world based on the free market.
7
Yes, exactly. Are we having "blue light specials" on colonoscopies this week? Better run down right now and get one while the savings last.
Or will we be hearing commercials yelling "SUNDAY, SUNDAY, SUNDAY !! Crazee Dave is having a half off sale on heart valve replacements! Don't miss these low,low prices. Even if you don't need one, you should get one! SUNDAY AT CRAZEE DAVE'S in downtown Scanton. Limit one per patient."
Or will we be hearing commercials yelling "SUNDAY, SUNDAY, SUNDAY !! Crazee Dave is having a half off sale on heart valve replacements! Don't miss these low,low prices. Even if you don't need one, you should get one! SUNDAY AT CRAZEE DAVE'S in downtown Scanton. Limit one per patient."
When have insurance prices, particularly covering medical care, EVER been lowered?
14
The problem with this small ball solution comes from how it was conceived. When alone in a room with no dissenting voices many ideas seem reasonable. The first thing to consider is the reason for the healthcare bill- it is to provide 800 billion for tax cuts not to improve healthcare. If that is not accomplished all other bills will not happen. About healthcare- first, people will die waiting for the six month penalty period to end. If they can't afford the coverage in the first place they won't get it and gamble on staying healthy. The second and third ideas reduce taxes that come from those who benefited from added healthcare spending.
What is needed in healthcare reform is figuring out first what is needed to create a healthcare system that serves the needs of the people, the kind of a thing a business does when creating a product, then figure out how best to provide it. Now the costs are too high compared to anywhere else in the world and results are poor. Healthcare is a right of life, liberty and happiness not a profit center.
What is needed in healthcare reform is figuring out first what is needed to create a healthcare system that serves the needs of the people, the kind of a thing a business does when creating a product, then figure out how best to provide it. Now the costs are too high compared to anywhere else in the world and results are poor. Healthcare is a right of life, liberty and happiness not a profit center.
14
That will never get passed.
First of all, it doesn't increase coverage nor lower premiums nor avoid Medicaid cuts, all things that candidate Trump had promised to achieve.
Secondly, the GOP has been turning Obamacare into "Armageddon" with their rhetoric, so now that many of the GOP base believe that myth, they will never accept an Obamacare-lite bill, that just would have some "tepid and incrementalist" changes.
Finally, Trump's extremist rhetoric, day after day, certainly fires up the GOP base too, but it makes it impossible for him to sign something "tepid" into law.
Conclusion: the GOP never thought that it would control DC entirely this year, so all their lies about Obamacare seemed to be "safe" to them, as they had nothing to lose and everything to win from it. Now that unexpectedly they do have to face reality, they're confronted with a totally impossible task: to deliver to their constituents, all while remaining true to their rhetoric.
There IS no solution for them here.
The only way out is that Trump goes back to his campaign promises, AND works mainly with the Democrats, who agreed with those promised, to improve Obamacare.
And then it will be the job of spin doctors to come up with some rhetoric that explains why this somehow would still be a "victory" for the GOP ...
First of all, it doesn't increase coverage nor lower premiums nor avoid Medicaid cuts, all things that candidate Trump had promised to achieve.
Secondly, the GOP has been turning Obamacare into "Armageddon" with their rhetoric, so now that many of the GOP base believe that myth, they will never accept an Obamacare-lite bill, that just would have some "tepid and incrementalist" changes.
Finally, Trump's extremist rhetoric, day after day, certainly fires up the GOP base too, but it makes it impossible for him to sign something "tepid" into law.
Conclusion: the GOP never thought that it would control DC entirely this year, so all their lies about Obamacare seemed to be "safe" to them, as they had nothing to lose and everything to win from it. Now that unexpectedly they do have to face reality, they're confronted with a totally impossible task: to deliver to their constituents, all while remaining true to their rhetoric.
There IS no solution for them here.
The only way out is that Trump goes back to his campaign promises, AND works mainly with the Democrats, who agreed with those promised, to improve Obamacare.
And then it will be the job of spin doctors to come up with some rhetoric that explains why this somehow would still be a "victory" for the GOP ...
19
Unfortunately little t doesn't remember his campaign 'promises' Nor does he care to. It's much more fun to attack women in the press.
1
Eliminating the mandate strikes me as a poor end goal. The United States stands out among developed nations in having failed to achieve universal coverage. And if the idea is that emergency rooms will take care of life threatening care for the uninsured, then Douthat needs to explain where the money for that care will come from.
22
Everyone requires healthcare insurance. You may have the DNA to live 150 years, but a careless driver could turn that around in an instant. A universal need should should not be saddled with a profit motive. Eliminate private healthcare insurance companies and their bloated overhead designed to turn greedy file clerks into undeserving billionaires. Medicare gets by with 2-3% overhead. Medicare for all is a sensible start, along with a requirement that all doctors must accept Medicare patients.
28
This is not a smart analysis. You are overlooking the role of media in shaping attitudes toward healthcare legislation.
Obamacare was a good start for changing the healthcare system, but Fox News made conservative-leaning Americans think it was poisonous.
The House and Senate repeal and replace bills are poisonous, but Fox News is trying to make conservative-learning Americans think it is a good start.
How can our country ever make progress when one giant cable network is never actually reporting news and instead is disseminating political propaganda?
Obamacare was a good start for changing the healthcare system, but Fox News made conservative-leaning Americans think it was poisonous.
The House and Senate repeal and replace bills are poisonous, but Fox News is trying to make conservative-learning Americans think it is a good start.
How can our country ever make progress when one giant cable network is never actually reporting news and instead is disseminating political propaganda?
53
Want a simple, efficient health care system? One that eliminates "the middle man" in the forms of advertising and litigation, and just pays for health care, not marketing and lawyers? It's called Single Payer. Medicare for Everyone. No more mandates, no more penalties for not having continuous coverage, you're covered. Period.
51
I wonder how all the people who demonize Medicaid will feel when they realize that they now have to provide all the care for Grandpa and Grandma because said grandparents have blown through all their money and can no longer afford their assisted living / nursing home / home health care. I guess we will find out sooner rather than later, as all the aging baby boomers hurtle toward old age and infirmity.
35
The Republicans "forge" ahead with small ball politics on healthcare. Can't really reconcile the forging with GOP smallness, meanness, and deceit. I don't believe they forge anything but an alliance with their billionaire donors, big business and profiteering religious backers.
They'll keep providing less government by chipping away at any redistribution to the lower 90%. More guns, less butter, and somehow the GOP expects us to be grateful for their forging.
They'll keep providing less government by chipping away at any redistribution to the lower 90%. More guns, less butter, and somehow the GOP expects us to be grateful for their forging.
10
It would be nice if all of this commentary would acknowledge that all of the proposed reforms only deal with the individual insurance market. The objections to government involvement in health care and insurance are disingenuous at best when we consider the heavy government involvement in group insurance coverage that is provided, tax-free, by corporate employers.
Instead of arguing about subsidies and mandates that affect the individual market, why not just mandate issuance of group coverage for those whose employers don't provide coverage options. Anyone who is not part of a group, for whatever reason, could join that group by paying both the employer and employee costs, and would get the same tax benefits that the average employer and employee get. Simple solution and fair to all citizens.
The sad truth is that corporate group members are not willing to acknowledge that they already have government-enabled and subsidized insurance, but don't support the same benefits for other citizens.
Instead of arguing about subsidies and mandates that affect the individual market, why not just mandate issuance of group coverage for those whose employers don't provide coverage options. Anyone who is not part of a group, for whatever reason, could join that group by paying both the employer and employee costs, and would get the same tax benefits that the average employer and employee get. Simple solution and fair to all citizens.
The sad truth is that corporate group members are not willing to acknowledge that they already have government-enabled and subsidized insurance, but don't support the same benefits for other citizens.
7
You have a good discussion that rarely get integrated into the dialog. It is a pecking order the United States chose ages ago not realizing how it would affect the very workers children and grandchildren, and now great-grandchildren.
2
Jazz Paw,
Thank you. I see hundreds and hundreds of comments on any healthcare article, but aside from myself and maybe one other, this is never mentioned or responded to.
My comment on a recent article:
Those who argue for "single payer" and "Medicare for all" completely ignore the "Harry and Louise" problem.
People are simply unwilling to even mention the fact that something like 50% of the population *already gets taxpayer subsidized insurance* in what their employer provides. And this obviously benefits the employers as well, who escapes lots of taxes.
So, where are the votes for single-payer? Medicare recipients? VA? Medicaid?
It all adds up to probably 80% of the population that would be susceptible to fear-mongering about change-- about the great American fear, that someone else, particularly "those people", will end up better off, at "my" expense.
Sorry, but the process started by ACA, which President Obama acknowledged would not be quick, is likely the only way to move forward.
Incremental progress in the many areas that the comments have addressed, through leveraging what influence the government has, is the most realistic approach. I wish I were wrong...
Thank you. I see hundreds and hundreds of comments on any healthcare article, but aside from myself and maybe one other, this is never mentioned or responded to.
My comment on a recent article:
Those who argue for "single payer" and "Medicare for all" completely ignore the "Harry and Louise" problem.
People are simply unwilling to even mention the fact that something like 50% of the population *already gets taxpayer subsidized insurance* in what their employer provides. And this obviously benefits the employers as well, who escapes lots of taxes.
So, where are the votes for single-payer? Medicare recipients? VA? Medicaid?
It all adds up to probably 80% of the population that would be susceptible to fear-mongering about change-- about the great American fear, that someone else, particularly "those people", will end up better off, at "my" expense.
Sorry, but the process started by ACA, which President Obama acknowledged would not be quick, is likely the only way to move forward.
Incremental progress in the many areas that the comments have addressed, through leveraging what influence the government has, is the most realistic approach. I wish I were wrong...
Ross, I really, really suggest you spend some time experiencing poverty. At the very least, read Nickeled and Dimed, by Barbara Ehrenreich, as the book details the absolute misery and struggle of getting by on minimum wage. You don't suggest people living on minimum wage be the subjects of experiments with the funding of their heathcare. How about if the insurance company executives experiment with lower salaries? How about if you experiment with working for minimum wage for one year? How about if Congress experiments with having to deal with the health insurance twists and turns that the rest of us do? How about if Republicans experiment with believing basic science, math, economics and the idea that all lives have value and deserve to be valued?
89
The Medicaid per-capita cap amounts to state-run death panels. Some groups of people who need care will not get all the care they need to stay alive (those in nursing homes) or functioning (people with disabilities) or to prevent more expensive future problems (child health care). If we are our brothers' keepers, we would do less keeping. There is no mention of replacing government assistance with large increases in private charity.
Whether we keep society's losers alive or healthy is going to be more a private choice of the winners instead of a forced commitment of the whole populace, like the basic education of the young. And states that used to export their extra people to other states after spending peanuts to educate them, will now be able to force their disabled to move to more generous locales.
Whether we keep society's losers alive or healthy is going to be more a private choice of the winners instead of a forced commitment of the whole populace, like the basic education of the young. And states that used to export their extra people to other states after spending peanuts to educate them, will now be able to force their disabled to move to more generous locales.
8
Even the state's obligation to educate the young is slipping away. Public schools are on the endangered list as private, charter, or whatever you want to call it, for-profit schools siphon all the money away. So basically our country seems to be heading to a place where it's every person for theirselves, no concern for fellow citizens, and we will become the Hunger Games.
21
First of all, I don't accept your political premise. "The Democratic bill in 2010 delivered significantly to the party’s base; the Republican bill in 2017 delivers significantly only to the party’s donors." The desire to repeal Obamacare is NOT limited to just donors; over 80% of self-identified Republicans want Repeal and Replace.
Second, I simply fail to see much difference between what you propose and the Senate version (BCRA) other than two main points:
(1) Scale of Medicaid Cuts - Even independent of the savings from Medicaid reductions, I think the Republicans are correct in principle. What sense does it make that core Medicaid (< 100% poverty limit) has been a 50/50 split with states since the 1960's yet Medicaid expansion warrants the federal government kicking in 95% ? If some states want to be more generous, that's their right under the 10th amendment. But shouldn't that choice carry with it at least the same financial obligation that has existed for 50 years ?
(2) Community Rating - As far as the exchanges, the Senate version actually keeps the structure of Obamacare. The subsidies are actually quite similar. The difference is not in the subsidy but rather in the premium itself. Obamacare forces the young to pay much more than they should to subsidize the elderly. As a result, the young decline to participate and you get insurer losses and exits from the market.
Second, I simply fail to see much difference between what you propose and the Senate version (BCRA) other than two main points:
(1) Scale of Medicaid Cuts - Even independent of the savings from Medicaid reductions, I think the Republicans are correct in principle. What sense does it make that core Medicaid (< 100% poverty limit) has been a 50/50 split with states since the 1960's yet Medicaid expansion warrants the federal government kicking in 95% ? If some states want to be more generous, that's their right under the 10th amendment. But shouldn't that choice carry with it at least the same financial obligation that has existed for 50 years ?
(2) Community Rating - As far as the exchanges, the Senate version actually keeps the structure of Obamacare. The subsidies are actually quite similar. The difference is not in the subsidy but rather in the premium itself. Obamacare forces the young to pay much more than they should to subsidize the elderly. As a result, the young decline to participate and you get insurer losses and exits from the market.
Many Republicans want repeal of Obamacare and replacement of their Obamacare benefits with equal benefits that will represent a repudiation of Obamacare.
8
Young people who guarantee to never become elderly should not have to subsidize the elderly. Framing this into law may be complicated.
15
A young person also pays much more in car insurance.
When Scott Brown won the special election Senate race in Massachusetts it had nothing to do with Obamacare. Massachusetts already had Romneycare that was the basis of the ACA, and it has always been popular. Brown won largely because the candidate that came out of the Democratic primary with a plurality was the weakest and aside from the normal vagaries of a special election the election was held when the many registered college students were on break and out of town. Brown never really was close in defending his seat, that was won by Elizabeth Warren who is and was a stalwart partisan of Obamacare plus.
17
The Republican blockade of medicaid expansion has left a huge population of poor people without access to health care in red states like Texas, Florida and Alabama.
Obamacare never got fully implemented - why are we talking about cutting medicaid now? Medicaid needs to be expanded to poor people trapped in red states.
Ross Douthat seems oblivious to realities on the ground. He offers no plan to get health care to poorer r citizens. He fancies himself broad-minded and reasonable because he is willing to ignore the death and suffering of fewer people than some other Republicans.
Obamacare never got fully implemented - why are we talking about cutting medicaid now? Medicaid needs to be expanded to poor people trapped in red states.
Ross Douthat seems oblivious to realities on the ground. He offers no plan to get health care to poorer r citizens. He fancies himself broad-minded and reasonable because he is willing to ignore the death and suffering of fewer people than some other Republicans.
21
The good news is that global warming will rid the nation of the albatross of backward southern states.
1
Didn't think I could write one more time. The "Repeal and Replace" was a rowdy rant during the election season and sure as heck caught on. However, how can it be that it is taken so literally from a man who, each and every day, is having his tweets and comments reconstructed for the desire of the receiver.
Those I speak with had no idea what "repeal" meant for implementation. They wanted essential benefits with an affordable price. Choice didn't mean to them which "skinny plan" would you like. They want what other nations seem to have found. No longer do they want to fear the loss of coverage because of a job loss or change, no longer do they want to fear bankruptcy because of illness or accident, and they want to be able to move or start their own business without having to think about health insurance first.
Most believe in the importance of Medicaid for those in need.
For me, I find this process that fast forwards almost the most important thing in everyone's life appalling. No public input from the doctors, hospitals, nurses, Leagues of Women Voters, etc.
This bill takes this country back to the early 1990's. Since then there have been decades of study. How on earth did these two bills evolve out of all that effort.
Those I speak with had no idea what "repeal" meant for implementation. They wanted essential benefits with an affordable price. Choice didn't mean to them which "skinny plan" would you like. They want what other nations seem to have found. No longer do they want to fear the loss of coverage because of a job loss or change, no longer do they want to fear bankruptcy because of illness or accident, and they want to be able to move or start their own business without having to think about health insurance first.
Most believe in the importance of Medicaid for those in need.
For me, I find this process that fast forwards almost the most important thing in everyone's life appalling. No public input from the doctors, hospitals, nurses, Leagues of Women Voters, etc.
This bill takes this country back to the early 1990's. Since then there have been decades of study. How on earth did these two bills evolve out of all that effort.
26
Ross, I think your column is reasonable. But a few more things can be done:
1. Define what constitutes basic care. Just take Canada as and example - drugs are not covered there. Similarly addiction treatment fund should be phased out over 5 years or so. Best way to treat is not to get addicted or if addicted put them in jail so they can die there.
2. The wait period for in-insured is good - I prefer up to 12 months (not 6 months) - one month for each uninsured month in last 2 years. But this will affect middle class too much. Another provision should be introduced here. I call is expanding HSA for after-tax contribution. Say, those who contributed 10% of income into HSA should get 1 month waiver in wait period for every year's contribution. This will be an alternative way of helping poor but responsible people.
3. Those are with HSA (as in 2 above) but without enough money a risk-pool may be created by state where state will pay for some of the treatment but IRS will collect additional 10% tax from such individuals to pay back to the state. Such risk-pool may be funded by tax-deductible donations by rich people.
4. But what will you do when uninsured people shows up in the doorstep of emergency room. Rule should be introduced, if someone NOT unconscious may not be allowed in unless he is maintaining insurance or HSA.
1. Define what constitutes basic care. Just take Canada as and example - drugs are not covered there. Similarly addiction treatment fund should be phased out over 5 years or so. Best way to treat is not to get addicted or if addicted put them in jail so they can die there.
2. The wait period for in-insured is good - I prefer up to 12 months (not 6 months) - one month for each uninsured month in last 2 years. But this will affect middle class too much. Another provision should be introduced here. I call is expanding HSA for after-tax contribution. Say, those who contributed 10% of income into HSA should get 1 month waiver in wait period for every year's contribution. This will be an alternative way of helping poor but responsible people.
3. Those are with HSA (as in 2 above) but without enough money a risk-pool may be created by state where state will pay for some of the treatment but IRS will collect additional 10% tax from such individuals to pay back to the state. Such risk-pool may be funded by tax-deductible donations by rich people.
4. But what will you do when uninsured people shows up in the doorstep of emergency room. Rule should be introduced, if someone NOT unconscious may not be allowed in unless he is maintaining insurance or HSA.
3
And, and, and, but if the emergemcy room patient regains consciousness the IRS has to charge them 10% or at least ask them for a tax deductible donation to the risk pool funded by rich people.
Drugs aren't covered but the Canadian government negotiates to get the best price, something thanks to Big Pharma's Republican chums, the government is prevented from doing in the US>
'
'
There is no support in the country for cutting Medicaid, it was not part of the Republican-promised "repeal and replacement" of the ACA, and it was not campaigned on.
It is not just for poor people, or people trying to dodge work, as the Republicans still hint at whenever they talk about it. It is disabled people, children with special needs and more than half the elderly in nursing homes.
Gutting it is just a Paul Ryan-Ayn Rand-Republican wish that they are trying to tack on to repeal and replace and hope nobody notices. When pressed, they will say that Medicaid is "unsustainable." But to quote someone I heard recently, saying Medicaid is "unsustainable" is like saying that driving west in New Jersey is unsustainable, because you will eventually drive into the Pacific Ocean.
And it is the camel's nose, if they succeed here, next up will undoubtedly be Social Security and Medicare.
It is not just for poor people, or people trying to dodge work, as the Republicans still hint at whenever they talk about it. It is disabled people, children with special needs and more than half the elderly in nursing homes.
Gutting it is just a Paul Ryan-Ayn Rand-Republican wish that they are trying to tack on to repeal and replace and hope nobody notices. When pressed, they will say that Medicaid is "unsustainable." But to quote someone I heard recently, saying Medicaid is "unsustainable" is like saying that driving west in New Jersey is unsustainable, because you will eventually drive into the Pacific Ocean.
And it is the camel's nose, if they succeed here, next up will undoubtedly be Social Security and Medicare.
26
Why the hatred of this health insurance mandate?
I have not had an auto accident in my 58 years of driving, but I am required to have auto insurance. Is this fair? Or is this just the way any insurance works?
I have not had an auto accident in my 58 years of driving, but I am required to have auto insurance. Is this fair? Or is this just the way any insurance works?
179
Yes! I have been saying this for months. Insurance is exactly that: it is a societal pool. If you don't buy car insurance you don't get a license. Simple. If you want to rent a car you have to buy the rental companies insurance. How come the Republicans don't find this concept outlandish?
Too divided? Yes. Too incompetently led? For sure ... and I''m waiting for an R friend to tell me she or he's embarrassed. But too confused reflects the real problem. The Rs in Congress simply don't understand the issue, for they claim a free market solve all ills. (Markets require equal knowledge and no coercion. Not so much when I'm having an MI.) No First World country does market-based health care. Maybe our peers--they all spend less for positive outcomes--know something. What we do and have done for many, many decades reflects the poorest of choices at every turn. Going small or big will leave us badly, for the majority simply doesn't care about our health. (Gotta love the old white folks who vote R and: (a) don't remember how vigorously their party fought Medicare in 1965; and (b) don't get the fact that Medicaid pays for them and theirs when they run out of funds, late in life, and need in-patient care.)
16
Free markets and religion are both based on myth.
1
"They can forge ahead with the “repeal” (really just the reform) of Obamacare"
No, it is repeal, because there are no new ideas, just repeal of existing efforts. Reform would be to fix something, and Republicans have no idea how to do that, can't even agree on the barest outlines of a proposal.
"The various health care tax cuts I just outlined would cost (roughly) $100 billion. So that’s approximately $250 billion that the small-ball bill would need to find in spending cuts."
The cuts need to come from the cost of medical services. We pay about 8% of GDP too much for less service than other modern societies get. That is about $1.5 trillion in savings per year, after providing care for everyone. No spending cuts needed.
The increments proposed here are like the proposals of the Board of Education to cut something popular like high school football if they don't get a millage increase -- propose anything but a reasonable solution because they don't want a reasonable solution, they want what they are demanding. In this case, it is repeal and tax cuts they want.
No, it is repeal, because there are no new ideas, just repeal of existing efforts. Reform would be to fix something, and Republicans have no idea how to do that, can't even agree on the barest outlines of a proposal.
"The various health care tax cuts I just outlined would cost (roughly) $100 billion. So that’s approximately $250 billion that the small-ball bill would need to find in spending cuts."
The cuts need to come from the cost of medical services. We pay about 8% of GDP too much for less service than other modern societies get. That is about $1.5 trillion in savings per year, after providing care for everyone. No spending cuts needed.
The increments proposed here are like the proposals of the Board of Education to cut something popular like high school football if they don't get a millage increase -- propose anything but a reasonable solution because they don't want a reasonable solution, they want what they are demanding. In this case, it is repeal and tax cuts they want.
13
The road to an improved medical coverage runs straight through changes to the immigration laws. The Republicans should offer the Dems support for AFA in exchange for reductions in the waves of immigration. Instead of having an immigration rate of about 1.5 million people a year, reduce the goal to 250 thousand.
The reality is that it is the huge numbers of immigrants who flood the emergency rooms that drain the finances of the medical system.
Our population went from around 200 million in 1980 to over 300 million in 2010. 30 years of massive population growth (50%) that has seen ever diminishing standard of living for American citizens. Not to mention the disastrous impact on the environment, climate change and other living things. We don’t want a population over 400 million – coming soon. We don’t need 1 out of every 2 babies being born paid for with Medicaid.
One other fact that proponents of large scale immigration always claim is that Spanish immigrants have lower crime rate than the average American. However this is a deliberate distortion. The very high and unfortunate crime rate of the black population throws out the averages. Remove their numbers and Hispanic immigrant crime rate is noticeably higher than the white population.
Not knocking immigration, Hispanics or other groups, but the huge numbers are stressing out social services including medical care. Time to respect limits to what earth can sustain.
This would be a win-win for Americans and the planet.
The reality is that it is the huge numbers of immigrants who flood the emergency rooms that drain the finances of the medical system.
Our population went from around 200 million in 1980 to over 300 million in 2010. 30 years of massive population growth (50%) that has seen ever diminishing standard of living for American citizens. Not to mention the disastrous impact on the environment, climate change and other living things. We don’t want a population over 400 million – coming soon. We don’t need 1 out of every 2 babies being born paid for with Medicaid.
One other fact that proponents of large scale immigration always claim is that Spanish immigrants have lower crime rate than the average American. However this is a deliberate distortion. The very high and unfortunate crime rate of the black population throws out the averages. Remove their numbers and Hispanic immigrant crime rate is noticeably higher than the white population.
Not knocking immigration, Hispanics or other groups, but the huge numbers are stressing out social services including medical care. Time to respect limits to what earth can sustain.
This would be a win-win for Americans and the planet.
3
As a child of legal immigrants, I think generalizations are dangerous, but we should ban anchor babies. That law was designed to protect ex-slaves after the civil war.
2
More Hispanics are leaving the U.S. than arriving, so that it no longer a problem.
As far as the population increase, we need to encourage birth control. Merely cutting off Medicaid will not do a thing for that. Or was your plan for people to starve?
As far as the population increase, we need to encourage birth control. Merely cutting off Medicaid will not do a thing for that. Or was your plan for people to starve?
Please explain how preventing immigration to America reduces the earth's population.
The US stubbornly persists in having one of the most backward national healthcare plans among the democracies of the Occident. Yes, I think that people should be required to have health insurance. No, I do not believe that only government bureaucracy could assure such a universal coverage. Apart from that, the present rope-pulling in Congress is nothing but an expression of Trump's personal hatred of Obama's laws. Who knows, whether his reasons are rational (that is, if is capable of rational thinking), political, ideological or even racially motivated? The price is meanwhile paid by the under-insured.
10
Every developed country in the world, almost 40 of them, has a system of universal health care MANDATED AND REGULATED by GOVERNMENT. Only in the feverish imaginations of ignorant republicans is there an alternative.
Should individuals be required to carry adequate health insurance at their own expense, or, if they are unable, with the assistance of government subsidies?
Opponents of a health insurance mandate, like Mr. Douthat, say such a requirement infringes on their individual liberty by forcing them to purchase something against their will.. Proponents say the absence of such a mandate infringes on their individual liberty by forcing them to pay for the healthcare of the uninsured when they present themselves for expensive care with junk coverage or no coverage at all.
Individuals should not be forced to buy health insurance against their will. Therefore the individual mandate of the Affordable Care Act should be repealed. In addition, taxpayers, the insured and healthcare providers should not be mandated to pick up the costs of treatment for the uninsured under any condition against their will. Therefore, he also called for the repeal of the mandate in the Emergency Medical Treatment and Labor Act (EMPTALA) of 1986 requiring hospitals to accept and treat patients with an emergency.
“And what are you going to do with the person in need of emergency care?” Here's a wild thought we are all thankfully too compassionate to seriously entertain: “Let im die,”
Opponents of a health insurance mandate, like Mr. Douthat, say such a requirement infringes on their individual liberty by forcing them to purchase something against their will.. Proponents say the absence of such a mandate infringes on their individual liberty by forcing them to pay for the healthcare of the uninsured when they present themselves for expensive care with junk coverage or no coverage at all.
Individuals should not be forced to buy health insurance against their will. Therefore the individual mandate of the Affordable Care Act should be repealed. In addition, taxpayers, the insured and healthcare providers should not be mandated to pick up the costs of treatment for the uninsured under any condition against their will. Therefore, he also called for the repeal of the mandate in the Emergency Medical Treatment and Labor Act (EMPTALA) of 1986 requiring hospitals to accept and treat patients with an emergency.
“And what are you going to do with the person in need of emergency care?” Here's a wild thought we are all thankfully too compassionate to seriously entertain: “Let im die,”
5
Social Darwinism is a favorite of Ayn Rand libertarians. Why should Americans be burdened by the sick and poor. Whether it is children or the elderly, if you don't have the means it is not my problem. If you get addicted to your prescribed opiates after a surgery that is not my problem. The weak, the poor, the elderly, the addicted... leave them to their own devices and they will die. Then they are no longer a problem. The strong survive. That is natural. Why should I sacrifice?
It is also complete garbage. Physicians presented with a sick patient have a sacred duty to save them. To treat them. Regardless of cost. There is not a religion in our world that does not preach that it is the responsibility of those who have the means to take care of the sick and poor. Every religion and culture has some version of do unto others... Basic morals demand compassion.
What kind of society have we become where we are so greedy that we can not find it within our hearts to love our neighbor, to take care of our parents, to feed our children and to take care of our planet.
Mr. Mannello, some day you might find yourself in a position where you can't take care of yourself, your parents or your children. At that time you will wish and pray that someone will be there to help you out. You will need people like me, people who reject Social Darwinism, people who appreciate that every life is precious... much more precious than a new TV.
It is also complete garbage. Physicians presented with a sick patient have a sacred duty to save them. To treat them. Regardless of cost. There is not a religion in our world that does not preach that it is the responsibility of those who have the means to take care of the sick and poor. Every religion and culture has some version of do unto others... Basic morals demand compassion.
What kind of society have we become where we are so greedy that we can not find it within our hearts to love our neighbor, to take care of our parents, to feed our children and to take care of our planet.
Mr. Mannello, some day you might find yourself in a position where you can't take care of yourself, your parents or your children. At that time you will wish and pray that someone will be there to help you out. You will need people like me, people who reject Social Darwinism, people who appreciate that every life is precious... much more precious than a new TV.
Any sane society has laws that limit free will. Hopefully, they make sense. Our universe is based on natural laws.
1
A good friend of mine just had a heat attack.
He doesn't have the time to go shopping for healthcare. He has had heart problems for a few years now. Before the ACA, he couldn't get coverage.
You Republicans are really outrageous that you continue to peddle the fraud and lie of free market for health insurance.
Why don't you want to get rid of the middle man where by the CEOs of health insurance companies get paid millions of dollars to figure out how NOT to cover people for their health problems? Why don't you allow Medicare to negotiate drug costs if you are so pro-free market?
Why?
Because you are feckless, moral quislings.
And you call yourself Christians.
He doesn't have the time to go shopping for healthcare. He has had heart problems for a few years now. Before the ACA, he couldn't get coverage.
You Republicans are really outrageous that you continue to peddle the fraud and lie of free market for health insurance.
Why don't you want to get rid of the middle man where by the CEOs of health insurance companies get paid millions of dollars to figure out how NOT to cover people for their health problems? Why don't you allow Medicare to negotiate drug costs if you are so pro-free market?
Why?
Because you are feckless, moral quislings.
And you call yourself Christians.
398
If you hear someone say "shop around for healthcare," you know you do not have to take anything else they say seriously. Lives are at stake and these guys act like one should have a shopping app.
1
You nailed it.
1
Precisely.
We have to give the Democrats some credit for getting the ball rolling on improving the disastrous health insurance system which left many under employed people unable to get any care. Obama and the Democrats took a big political risk and paid the price for it. But, that is what voters have said they like in politicians, those willing to stand up for their beliefs. I felt that Obamacare was reinventing the wheel and hope we can move on to medicare for all. At least we can give voters a choice to buy into the medicare system for basic care.
16
So Douthat notices that the bill is good for no one but the donors. Surely this must be a mistake! Never fear, Ross to the rescue!
Be sure to stay up tonight, Mr. Douthat. A grateful Senator McConnell will be calling you any minute now.
Be sure to stay up tonight, Mr. Douthat. A grateful Senator McConnell will be calling you any minute now.
12
The juxtaposition in today's paper of the conservative wonk Douthat's prescription for a Republican health care fix and the field reporting of Abby Goodnough on the actual recipients of Medicaid services was, indeed, a study in contrasts. While the former euphemistically called for an "experiment in entitlement reform",i.e. reductions in Medicaid funding, the latter revealed the utter necessity of this federal program to their lives. It's important, even ethically required, to leave the office sometimes and see how the "other half" exists before espousing ideas that would so dramatically impact those lives.
15
"True, eliminating the mandate would lead to less coverage. But if the subsidies didn’t change and the Medicaid cuts were limited, much of any drop-off would be genuinely voluntary."
Hmmm.... is that "voluntary" as in "I got laid off and we can't pay the insurance bill for a couple months"? According to the Republican plan, this circumstance would require you to "voluntarily" lose healthcare for eight months. That should work fine -- as long as the kids agreed to "voluntarily" not get sick for the better part of a year. Also important, it would teach you to take personal responsibility for whether or not you lose your job.
It is notable that Mr. Douthat conducts this entire argument with the implicit assumption, never stated, that there would be something worthwhile in the Republicans passing a bill, any bill. There is no discussion of the moral dimension of pushing people off healthcare. I guess Mr. Douthat thinks that would be fine, as long as they were pushed "voluntarily."
Hmmm.... is that "voluntary" as in "I got laid off and we can't pay the insurance bill for a couple months"? According to the Republican plan, this circumstance would require you to "voluntarily" lose healthcare for eight months. That should work fine -- as long as the kids agreed to "voluntarily" not get sick for the better part of a year. Also important, it would teach you to take personal responsibility for whether or not you lose your job.
It is notable that Mr. Douthat conducts this entire argument with the implicit assumption, never stated, that there would be something worthwhile in the Republicans passing a bill, any bill. There is no discussion of the moral dimension of pushing people off healthcare. I guess Mr. Douthat thinks that would be fine, as long as they were pushed "voluntarily."
36
BG is correct here on the effects on human beings. Also, Douthat should read some of the economists who in the New York Times have repeatedly explained in simple English what happens when you remove the mandate. The whole structure collapses. Mr Douthat, who has several times claimed to be a Christian, should pray for guidance on whether the resulting medical catastrophe would really be God's will.
1
Cutting taxes on the wealthy will solve all of everyone's problems. Who cares if risk pools are too small and the actuaries can't make it work. Get rid of the individual mandate. Tax cuts for the wealthy to the rescue!
11
Where is the money for any "reform"? The main reason for repeal is the extra tax on the wealthy.
Any insurance can be made cheaper by cutting benefits and increasing deductions so much that that it is worthless when needed.. Obamacare increased coverage so much that premiums went up for better policies.
You get what you pay for- better coverage and high overhead with private insurance. Insurance companies lose in competition with Medicaid /Medicare for all, which is why Obama included insurance exchanges.
Any insurance can be made cheaper by cutting benefits and increasing deductions so much that that it is worthless when needed.. Obamacare increased coverage so much that premiums went up for better policies.
You get what you pay for- better coverage and high overhead with private insurance. Insurance companies lose in competition with Medicaid /Medicare for all, which is why Obama included insurance exchanges.
6
I don't pretend to have all the answers concerning health care. But Mr. Douthat's "solution," which includes allowing people "voluntarily" to forgo health care coverage, is obviously flawed. When those people get sick or are injured, hospitals are legally (and morally, I hope) required to care for them. In order to pay for that care, the hospitals will impose higher costs on the rest of us. That arrangement isn't fair and shouldn't be part of our health care system.
12
Paying for indigents' emergency care is no less fair than other types of wealth transfer via health insurance. The real problem is that waiting for an emergency before you pay for care is the most expensive way to do it. Prevention and treatment at an early stage is cheaper, not to mention better for the patient.
1
Yep, the GOP system is based on parasitism. The truly responsible person has health insurance and doesn't depend on strangers if things go wrong. Under the GOP system that person is a chump. (That person by the way is me. I studied and worked hard, paid my fair taxes not Trump taxes, and paid full price into insurance for 20+ year as a healthy person - now self employed on ACA with a new health condition. The GOP is spitting in my face. If they destroy my coverage while expecting local hospitals to pick up free loaders, I am done paying US taxes- can easily relocate abroad. To tell you the truth it's almost worth it just to avoid seeing their smirking, publically-funding faces on the TV every day. Paul Ryan is the ultimate welfare queen).
1
Douthat's idea is already PROVED by the vast numbers of young workers who have steadily refused to buy any health insurance for the past 7 years. The proof is in the marketplace.
When the clear-eyed and truthful admit what is real, the dreamers line up to throw things at them.
When the clear-eyed and truthful admit what is real, the dreamers line up to throw things at them.
Why "go small" when the only morally acceptable solution is universal healthcare? Anything else will cause untold suffering and the deaths of thousands of americans.
It seems to be yet another proposal that has little to do with healthcare and everything to do with an ideology that is disconnected from reality and/or the need to minimize the taxes of the very wealthy.
It seems to be yet another proposal that has little to do with healthcare and everything to do with an ideology that is disconnected from reality and/or the need to minimize the taxes of the very wealthy.
25
Remember it was the Heritage Foundation (the Conservative think tank) that demanded that a mandate to make younger people participate was a vital part for a health plan to work. Obama tried to include this but suddenly it became a No No.
The cost of medicine (which is the real issue) is due to out of control drug prices, to many unnecessary procedure, too much imaging and no regulations on these folks. We pay 50-60 % more for meds then other countries. Drug companies spend more on advertising then on research. They have 1000 lobbyists paying big bucks (78 million the first quarter of this year ) to our politicians.
The cost of medicine (which is the real issue) is due to out of control drug prices, to many unnecessary procedure, too much imaging and no regulations on these folks. We pay 50-60 % more for meds then other countries. Drug companies spend more on advertising then on research. They have 1000 lobbyists paying big bucks (78 million the first quarter of this year ) to our politicians.
15
This is a kinder gentler way to take away my health insurance It shows no vision for an inclusive healthcare system. Bottom line its another way to transfer wealth from those who need it to those who have more than they need already. Ross constantly speaks of community and solidarity but in the end he too would send many of his fellow citizens to their death Just remember this when Douthat preaches his religious doctrines that in the end it is dollars for the wealthy that have the highest value. It's not hard to be cynical about faith when this is an example of it's witnesses.
21
This "modest proposal" suggested by the columnist does not meet the republican party's stated mission of repealing and expunging the Affordable Care Act. Even if they were amenable to modifying the ACA along the lines of those suggested, the GOP leadership could not stomach retaining its name and original attributions. In the tribalistic mindset of these leaders, attributing any credit to the enemy is suicidal.
And when thinking about eliminating the individual mandate for health coverage, consider that we the public are paying for the health care of those lacking personal coverage. It gets passed on to the paying customers one way or another: Higher insurance premiums and co-pays and higher prices for hospital services. So unless we decide that those who avoid buying health insurance will NOT be treated in our emergency rooms after car accidents and other trauma, will NOT be given treatment for contagious and life-threatening infections or cancer, and will ignored unless they pay out of pocket, then we will continue to pay the cost of their care: it gets passed along to those who pony up and pay. Its either that or just watch them suffer and die. I think even the GOP cannot stomach that. I think.
The individual mandate requires individuals to pay their fair share into the system, and if they elect not too, they should be taxed accordingly (as provided in the ACA) to cover the expenses they will surely generate. Expenses that we the payers will be covering.
And when thinking about eliminating the individual mandate for health coverage, consider that we the public are paying for the health care of those lacking personal coverage. It gets passed on to the paying customers one way or another: Higher insurance premiums and co-pays and higher prices for hospital services. So unless we decide that those who avoid buying health insurance will NOT be treated in our emergency rooms after car accidents and other trauma, will NOT be given treatment for contagious and life-threatening infections or cancer, and will ignored unless they pay out of pocket, then we will continue to pay the cost of their care: it gets passed along to those who pony up and pay. Its either that or just watch them suffer and die. I think even the GOP cannot stomach that. I think.
The individual mandate requires individuals to pay their fair share into the system, and if they elect not too, they should be taxed accordingly (as provided in the ACA) to cover the expenses they will surely generate. Expenses that we the payers will be covering.
15
Thank you for trying. It's a more serious attempt then we've heretofore seen.
2
Why do the republicans and Donald Trump think that by letting more Americans go without health insurance thereby causing the preventable deaths of tens of thousands Americans will make this country great? If they don't think that, why are they trying to pass this legislation at all?
27
The answer to your first question is this: Many of them do not believe that macro evolution takes place in the natural world. They do believe in social Darwinism, i.e. a version of "survival of the fittest" for humans. What a bizarre combination, in my opinion.
6
Universal healthcare for every human being is not ideology..it is common decency. If it was up to me I would also like to see some relief on vet bills but that is too much to ask.
20
There is more than one road available to Republicans that Democrats chose not to take, or lacked the ability to grasp when they had the power. Ross sees small-ball as the only alternative to ObamaCare OR the AHCA, but that's not the only choice.
Ross's compromise "smaller bill" not only wouldn't solve our healthcare nightmare but it would leave entrenched the dysfunctional, strategically insolvent, kludgey set of programs, that with the ACA have been around for decades and that brought us to this state. We need a ground-up reform of healthcare in America, and it's right there for Republicans to grab for the asking.
And, EXCUSE ME, maybe we can expect of Congress the ability to handle more than one complex task at a time, so perhaps we don't give up tax reform to get healthcare reform. Or maybe we fire those who can't walk and chew gum at the same time and replace them with pols who can.
We forget that by repealing the ACA we still would have Medicaid that is bankrupting our states, Medicare, the healthcare elements of Social Security, and employer-provided insurance; and we do nothing to address the fundamental problems facing each, not least among them inadequate funding and negative economic impact.
I don't make many hard predictions, but here's one: if I live a full life, then by its end I'll see a single-payer framework for delivering basic healthcare to ALL Americans, above which additional services may be obtained by subsidized insurance on exchanges.
Ross's compromise "smaller bill" not only wouldn't solve our healthcare nightmare but it would leave entrenched the dysfunctional, strategically insolvent, kludgey set of programs, that with the ACA have been around for decades and that brought us to this state. We need a ground-up reform of healthcare in America, and it's right there for Republicans to grab for the asking.
And, EXCUSE ME, maybe we can expect of Congress the ability to handle more than one complex task at a time, so perhaps we don't give up tax reform to get healthcare reform. Or maybe we fire those who can't walk and chew gum at the same time and replace them with pols who can.
We forget that by repealing the ACA we still would have Medicaid that is bankrupting our states, Medicare, the healthcare elements of Social Security, and employer-provided insurance; and we do nothing to address the fundamental problems facing each, not least among them inadequate funding and negative economic impact.
I don't make many hard predictions, but here's one: if I live a full life, then by its end I'll see a single-payer framework for delivering basic healthcare to ALL Americans, above which additional services may be obtained by subsidized insurance on exchanges.
10
Whether smart people in Congress see this reality and pursue it now, or whether we're forced over time to destroy BOTH parties as competing purist visions are sought that the people won't buy, all other paths inevitably will be foreclosed until we're left with this one: one program that does it all, acceptably and financially wearably, with all OTHER programs repealed.
This is an immense opportunity for congressional Republicans to declare a timeout and be honest with the American people: we need to re-imagine American healthcare from the ground-up, and it's just not important if ObamaCare remains in place until we do.
I fear, however, that Ross may be right and that no other but a retreat is possible with this crew of Freedom Caucus and fellow-travelers. But retreats don't win wars, guys, and rarely win elections. If you can't solve healthcare for all Americans, then how are you any better than Democrats?
This is an immense opportunity for congressional Republicans to declare a timeout and be honest with the American people: we need to re-imagine American healthcare from the ground-up, and it's just not important if ObamaCare remains in place until we do.
I fear, however, that Ross may be right and that no other but a retreat is possible with this crew of Freedom Caucus and fellow-travelers. But retreats don't win wars, guys, and rarely win elections. If you can't solve healthcare for all Americans, then how are you any better than Democrats?
8
I believe that what will bankrupt the states is the inadequate funding of pensions....not Medicare...promises made but not kept.
3
Healthcare costs always come down to how much healthcare do you provide to the sickest 15%. The sickest 15% consume 85% of healthcare. The sickest 5% consume 50%. The healthiest 50% consume just 3%. I worked for one of the largest health insurers for 20 years, and we studied quite rigorously the European models. The reason why Europeans live longer and spend about half what we do on insurance is that they focus on keeping the healthy people healthy, and much less on saving the sickest. Our healthcare system will spend unlimited amounts of money to keep people alive regardless of the situation, but very little on primary care, comparatively. This does not exist in the European models. Neither political party is willing to touch this with a ten foot pole. How do you tell Americans that the best way to live a long life as a nation is to reduce the medical care on the sickest and concentrate on keeping people who already are healthy, healthy?
The Swiss have shown that a strictly enforced mandate as well as competent negotiations with healthcare providers and drug companies on behalf of their citizens results in better healthcare at 2/3 the cost of ours.
35
@Willy E
True. But, as I've been arguing for years, the Swiss are also showing what kind of regulations and negotiations are necessary, and it would be unlike anything Americans have ever seen in terms of 'state intrusion' into the for-profit healthcare market...and the Swiss are STILL complaining about rising costs!
In other words, it's difficult. Even when all parties have a seat at the table and are negotiating very seriously about providing services at prices that make sense for consumers AND shareholders. It CAN be done, but I doubt Americans--and particularly its political system--is up to the job.
Americans would need to take government seriously enough to elect competent representatives that belong to a political party that holds, as a CORE VALUE, the notion of 'good governance' through honest discussion and compromise. We seem to be moving away from that, into some kind of funhouse mirror of absurdist representation--and no compromise!--in Washington.
True. But, as I've been arguing for years, the Swiss are also showing what kind of regulations and negotiations are necessary, and it would be unlike anything Americans have ever seen in terms of 'state intrusion' into the for-profit healthcare market...and the Swiss are STILL complaining about rising costs!
In other words, it's difficult. Even when all parties have a seat at the table and are negotiating very seriously about providing services at prices that make sense for consumers AND shareholders. It CAN be done, but I doubt Americans--and particularly its political system--is up to the job.
Americans would need to take government seriously enough to elect competent representatives that belong to a political party that holds, as a CORE VALUE, the notion of 'good governance' through honest discussion and compromise. We seem to be moving away from that, into some kind of funhouse mirror of absurdist representation--and no compromise!--in Washington.
8
HOWEVER. While we pay about 38% more than the Swiss do in total for health, Switzerland pays 83% more than the average of other developed countries and 53% more than France which is ranked number 1 by WHO. (figures from OECD)
12
Singapore has found that as well.
Mr. Douthat forget to tell us that Republican health care plans have nothing to do with improving helath coverage or cutting the health care costs. The plans are nothing but tax cut for 5% of the wealthiest Americans and plans to gut and destroy Medicaid as first step to dismantle Medicare and Social security that is stated long term plans of McConnell and Ryan. Any op ed or editorial that does no address the huge tac cut in the Republican plans is not worthy of any serios discussion.
33
@Hoshiar
That's probably why we'll never see a plan like Ross's actually appear from the mouths of the GOP claque. Because it IS chump change to those who were counting on nearly a $trillion being returned to their pockets over 10 years.
But $280 billion? Meh. (Hey, it's just as well. We can do a lot more useful things with $280 billion than they ever will.)
That's probably why we'll never see a plan like Ross's actually appear from the mouths of the GOP claque. Because it IS chump change to those who were counting on nearly a $trillion being returned to their pockets over 10 years.
But $280 billion? Meh. (Hey, it's just as well. We can do a lot more useful things with $280 billion than they ever will.)
Why does the conservative analysis always begin with the amount we're going to shave from safety net programs? In software engineering we would have a suite of edge cases to test design. What basket of individuals or families do you use to test your hypothetical policies?
16
The whole health care debate on what should be repealed,
done away with, fixed, improve, etc is on par with rearranging
the deck chairs on the Titanic.
What the country needs is Medicare for all people
60 and older, an ability to buy into the system for those
younger at fair premiums with assistance for those who
need monetary help. Private insurance would still be
available to those who want it, or want to supplement
their Medicare (such as what we now have).
And employers could still offer health insurance as a benefit
but it would be taxed as income.
Anyway, all people would have decent coverage. It would
end up being cheaper and more efficient, and there would be
choices in coverage.
done away with, fixed, improve, etc is on par with rearranging
the deck chairs on the Titanic.
What the country needs is Medicare for all people
60 and older, an ability to buy into the system for those
younger at fair premiums with assistance for those who
need monetary help. Private insurance would still be
available to those who want it, or want to supplement
their Medicare (such as what we now have).
And employers could still offer health insurance as a benefit
but it would be taxed as income.
Anyway, all people would have decent coverage. It would
end up being cheaper and more efficient, and there would be
choices in coverage.
23
How long is the waiting period?
Sure, I can be without insurance, be diagnosed with prostate cancer, and buy insurance. My choices are then:
1. Surgery and bankruptcy -- a lot of that will put stress on the system,the system, or
2. wait for the insurance to kick in, have a later-stage cancer that is more costly to treat.
Which is the better choice?
3. Individual mandate.
Sure, I can be without insurance, be diagnosed with prostate cancer, and buy insurance. My choices are then:
1. Surgery and bankruptcy -- a lot of that will put stress on the system,the system, or
2. wait for the insurance to kick in, have a later-stage cancer that is more costly to treat.
Which is the better choice?
3. Individual mandate.
33
In Ross' alternative world, "Republicans in 2017 can’t agree on what their health care policy goal should be." Meanwhile, here in the real world, the only thing that Republicans (except Ross) clearly agree on -- since they comically insist on inserting this hilarious and self-defeating provision in their actual bills -- is that they MUST pay back their idle-rich donors by ending the net investment income tax that is so hated by the 0.1%.
13
Universal healthcare has no mandate. instead, because it's there for everyone, nobody will feel "obligated" to join. Like public education. Nobody pays per child. You just go and register your child. Wherever you live, it's there.
The problem with an insurance model for healthcare is that people don't want to pay exorbitant insurance fees. Why should they? It's medical assistance they want. Not an insurance broker!
That's why a Universal model works very well. Just like water and sewage, garbage collection or mail service. Public transportation. Or your local school. Ok, so taxes would support the healthcare system. But everybody can use it! Without worries about getting sick - except the sickness or injury itself.
Sanity = Universal care for everyone.
The problem with an insurance model for healthcare is that people don't want to pay exorbitant insurance fees. Why should they? It's medical assistance they want. Not an insurance broker!
That's why a Universal model works very well. Just like water and sewage, garbage collection or mail service. Public transportation. Or your local school. Ok, so taxes would support the healthcare system. But everybody can use it! Without worries about getting sick - except the sickness or injury itself.
Sanity = Universal care for everyone.
316
For all its flaws, the ACA addressed a genuine need. The unique American "free-market" medical-industrial complex had a serious inherent failing: The imperative of insurers to serve shareholders required the exclusion of so many people from coverage that even insurance executives found the situation untenable. The ACA fixed that failing, even as it avoided the real reform our seriously broken system really needed. Reform would have given the United States the sort of true health care system enjoyed by citizens of every other "advanced" country, at the expense of interests that derive tremendous wealth from our medical-industrial complex.
The bills proffered by Republicans address no genuine needs. They solely advance Republican ideology, spitefulness, and bigotry, and serve the greed of their donors, at the expense of millions of people. They are "necessary" only because Republicans made obstructing Obama their sole agenda in 2009. When Democrats passed the ACA, they began a campaign of lies about the law and Obama, and made its repeal the cornerstone of their inflammatory campaigns. Now they must deliver on what they've been promising their base and donors for 7 years.
The cruelty of the "repeal" bills reflects that purely partisan imperative. They send a clear message that Republicans don't care about improving health care, or about anything else that benefits non-wealthy Americans. They only care about themselves and their donors. Everyone else is expendable.
The bills proffered by Republicans address no genuine needs. They solely advance Republican ideology, spitefulness, and bigotry, and serve the greed of their donors, at the expense of millions of people. They are "necessary" only because Republicans made obstructing Obama their sole agenda in 2009. When Democrats passed the ACA, they began a campaign of lies about the law and Obama, and made its repeal the cornerstone of their inflammatory campaigns. Now they must deliver on what they've been promising their base and donors for 7 years.
The cruelty of the "repeal" bills reflects that purely partisan imperative. They send a clear message that Republicans don't care about improving health care, or about anything else that benefits non-wealthy Americans. They only care about themselves and their donors. Everyone else is expendable.
129
The hated mandate is inevitably coupled to requring coverage for people with pre-existing conditions, replacing it with a 6 months waiting period is unlikely to reduce increases in insurance premous. The basic flaw of the mandates is that they were strong enough to discourage young healthy people from not purchasing insurance. The real solution is to have everybody pay taxes for health insurance pro-rated by income. The administration of payments can be done by either private or public entities, that is a subject worthy of political debate. But without a mechanism that includes everyone paying for insurance according to their means no universal coverage is possible.
17
I'm a reasonably optimistic, happy person, but please don't tell me to cheer up.
6
Great ideas, except that eliminating the mandate makes the whole thing collapse. You really don't understand the concept of insurance.
127
Eliminating the mandate! You are right. If you dump the mandate, insurance no longer works! Who doesn't understand that? Republicans and Mr. Douthat, obviously. (Or else they believe we are all suckers and don't have a clue.)
1
He's a free-market conservative, thus constitutionally incapable of seeing how markets actually work.
Stop treating health care like some discretionary commodity. When you do you'll conclude the only choice is single payer.
92
If Trump was really a shrewd businessman he would just push for Medicare for All. This would actually provide medicare care and not just junk insurance, and over the long run provide significant cost savings. This would guarantee him at least a second term in office. Not going to happen I know…
If only their was another political party that would embrace Medicare for All. They would win the voters for generations to come.
If only their was another political party that would embrace Medicare for All. They would win the voters for generations to come.
20
In reading some of these comments a reoccurring theme keeps appearing, Obamacare is just too expensive for individuals. It really sounds like a remake of the old song and dance about minimum wage.
When Oregon and Washington state decided to raise their minimum wage to a "living wage" the streets weren't flooded with unemployed, even McDonald's was able to adapt.
Unfortunately our divided Congress made to ability of flex the system out of reach and we now are at a crossroads on whether our government serves the people or only billionaires.
When Oregon and Washington state decided to raise their minimum wage to a "living wage" the streets weren't flooded with unemployed, even McDonald's was able to adapt.
Unfortunately our divided Congress made to ability of flex the system out of reach and we now are at a crossroads on whether our government serves the people or only billionaires.
12
The last word that's appropriate to describe anything the Republicans would want to do to health care is "incrementalist". Even no action on their part would be decremental, since they have already undermined the stability of health care.
And Ross, you don't understand the fundamental of insurance. For it to work effectively, you need the biggest possible pool and it's a fool's errand to push for any drop-off, even if it's "voluntary". Insurance is mandatory if you drive or own a house; that it's "hated" in healthcare is the result of years of propaganda by entrenched interests. Every one of the United States' peer nations understands that and has instituted universal coverage through single payer or a highly regulated private insurance market that is mandated to be non-profit for non-elective care.
It would be nice if you and your fellow-conservative writers would focus on helping achieve truly affordable medical care for all, and forget helping the Republican Party out of the political and moral mess it's in through every fault of its own. If anything gives you away, it's your plea to pull Medicare spending downwards, along with your casual "that's it".
And Ross, you don't understand the fundamental of insurance. For it to work effectively, you need the biggest possible pool and it's a fool's errand to push for any drop-off, even if it's "voluntary". Insurance is mandatory if you drive or own a house; that it's "hated" in healthcare is the result of years of propaganda by entrenched interests. Every one of the United States' peer nations understands that and has instituted universal coverage through single payer or a highly regulated private insurance market that is mandated to be non-profit for non-elective care.
It would be nice if you and your fellow-conservative writers would focus on helping achieve truly affordable medical care for all, and forget helping the Republican Party out of the political and moral mess it's in through every fault of its own. If anything gives you away, it's your plea to pull Medicare spending downwards, along with your casual "that's it".
16
Sounds very sensible, but it's all based on the assumption that the Republican bills are health-care bills, when they are, in fact, wealth-care bills. Their primary purpose is to roll back Obamacare taxes on the wealthy. What they do to health care is secondary.
31
Yup, money for the rich. And for insurance companies!
4
You clearly don't know any young people. My 20-something kid thinks he doesn't need health insurance because (1) he's young and invulnerable, and (2) if he has a health disaster, the ER has to save his life even if he can't pay.
You're not going to eliminate #1 by legislation. You could eliminate #2, but that would make it a bit too obvious how little the "pro-life" party actually cares about lives.
You're not going to eliminate #1 by legislation. You could eliminate #2, but that would make it a bit too obvious how little the "pro-life" party actually cares about lives.
19
Mr. Douthat, I would love to see a column from a conservative that explains why Republicans feel that all Americans should not have access to medical insurance and medical care. Why should people have to declare bankruptcy if they have a catastrophic illness? Healthcare will not magically be provided unless payment for services can be made.. Healthcare is big business, not charity.
How can you rationalize depriving any fellow Americans of the right to medical insurance? Lack of insurance coverage usually results in lack of medical care. By reducing medicaid you will have to determine which population is unworthy of medical treatment? Poor children don't vote, so maybe they would be targeted or maybe elderly and disabled in nursing homes would be a politically better target?
I strongly suggest you consult with your conscience before providing any more healthcare solutions.
How can you rationalize depriving any fellow Americans of the right to medical insurance? Lack of insurance coverage usually results in lack of medical care. By reducing medicaid you will have to determine which population is unworthy of medical treatment? Poor children don't vote, so maybe they would be targeted or maybe elderly and disabled in nursing homes would be a politically better target?
I strongly suggest you consult with your conscience before providing any more healthcare solutions.
130
Alison:
"I strongly suggest you consult with your conscience before providing any more healthcare solutions."
Your suggestion, noble as it is, rests on a tenuous assumption. Mr. Douthat has not demonstrated much evidence of a conscience beyond pre-conciliar legalism. In fairness, this is more of a conscience than that of many other conservatives, who seldom see beyond the (short term) fiduciary interests of their owners.
"I strongly suggest you consult with your conscience before providing any more healthcare solutions."
Your suggestion, noble as it is, rests on a tenuous assumption. Mr. Douthat has not demonstrated much evidence of a conscience beyond pre-conciliar legalism. In fairness, this is more of a conscience than that of many other conservatives, who seldom see beyond the (short term) fiduciary interests of their owners.
4
Oh, those columns are out there. Try the Wall Street Journal, where 23 million people can be ignored for the sake of "stimulating the economy."
The question was what exactly they trying to do, Reduction of Population ?.
18
In short keep everything that people like but eliminate the way we pay for what people like. Brilliant, now if you could add debtors prison for those that don't pay their emergency room bills, you can make it cruel enough for Ted Cruz. Good days work everybody.
16
Drop the mandate and you no longer have a true insurance situation. Imagine a person who has just been diagnosed with cancer finds he/she has to wait to get treatment because he/she has no insurance or it has lapsed. The howls over "death panels" that greeted the ACA would be faint bleeps in contrast to the justifiable outrage that would follow. Lots of people may hate the mandate, but they had better grow up and take their medicine if they want a viable health care system.
17
The ACA mandate: You have to have health insurance.
The GOP alternative: You can't have it. (Not if it's lapsed for two months, and for a specified time---but that time a mortal danger.)
The GOP alternative: You can't have it. (Not if it's lapsed for two months, and for a specified time---but that time a mortal danger.)
10
"...Senate Republicans keep making their bill more like, well, Obamacare, which raises the question of why they’re attempting something so complex for such a modest end."
The answer is that the aim remains what it has been for years, namely to diminish President Obama's legacy. Congressional Republicans had made dozens of attempts at repealing the ACA without even an outline of an alternative.
Now that Republicans were caught flat-footed, holding the White House and Congress, Paul Ryan chalked the failure up to "growing pains." Mitch McConnell could not even defend the secrecy with which the Senate approached a bill, other than citing his cliche about the imminent demise of Obamacare.
Trump, with no recourse from his party's public failure, has shrugged that they might as well repeal the law and kick the can down the road. To that extent the GOP is determined to hurt President Obama, that they will flippantly hurt the rest of us in the process.
The answer is that the aim remains what it has been for years, namely to diminish President Obama's legacy. Congressional Republicans had made dozens of attempts at repealing the ACA without even an outline of an alternative.
Now that Republicans were caught flat-footed, holding the White House and Congress, Paul Ryan chalked the failure up to "growing pains." Mitch McConnell could not even defend the secrecy with which the Senate approached a bill, other than citing his cliche about the imminent demise of Obamacare.
Trump, with no recourse from his party's public failure, has shrugged that they might as well repeal the law and kick the can down the road. To that extent the GOP is determined to hurt President Obama, that they will flippantly hurt the rest of us in the process.
6
"There is no innovation and creativity without failure. Period."~brene brown
The ACA was a republican idea developed by the heritage foundation. Obama tried it instead of going the Medicare for all route that was so popular with Democrats going back to Truman. He hoped to appeal to Republicans by using their plan but sadly partisan politics and racism got in the way so here we are.
If Republicans were smart they would work towards a bipartisan plan that would fix what's not working with the ACA. Sadly, rather than intelligence Republicans are demonstrating cruelty and greed. They will either force through something awful or allow the ACA to collapse due to deliberate neglect.
There was a time when the US was a place where great things happen. A century ago we led in education and innovation. We stole the best minds from around the world to come here and make America great. Now we're just old and cranky and a little crusty even. So now our great minds will go to France to change the world.
The ACA was a republican idea developed by the heritage foundation. Obama tried it instead of going the Medicare for all route that was so popular with Democrats going back to Truman. He hoped to appeal to Republicans by using their plan but sadly partisan politics and racism got in the way so here we are.
If Republicans were smart they would work towards a bipartisan plan that would fix what's not working with the ACA. Sadly, rather than intelligence Republicans are demonstrating cruelty and greed. They will either force through something awful or allow the ACA to collapse due to deliberate neglect.
There was a time when the US was a place where great things happen. A century ago we led in education and innovation. We stole the best minds from around the world to come here and make America great. Now we're just old and cranky and a little crusty even. So now our great minds will go to France to change the world.
18
Eliminating the mandate still means young and healthy people opting out. That undermines the whole way insurance works, spreading the costs and risks over a diverse pool. You pay more than you get back when you're healthy. If you get sick or injured -- which can happen to anyone -- you often get back more than you pay. What's the big deal with the mandate? Most states require auto insurance if you own a car. Plus having insurance provides preventive care to keep people healthy, instead of waiting for costly catastrophes and emergency room care we all subsidize.
8
Many on the Left think there is now an opening for single payer and if Republicans, by trying to replace Obamacare with no care, have made it possible, that would be nice but I remain skeptical.
So, for the sake of argument what’s it going to take to pass single-payer. Well, you need a President who is willing to sign it or two thirds of the House to override a veto (that’s 290 seats and Democrats currently hold 193). So, we need a President, and a majority in the House, 25 seats gets us there. We’ll need 60 votes in the Senate to overcome a filibuster, that’s a pickup of twelve senators, and we will need 5 votes in the Supreme Court to overcome the inevitable court challenge. It isn’t necessary but it would be nice to have control of more states to help with implementation, Democrats currently control 13 states. So, as you can see it is a pretty big climb to the top of single-payer mountain.
In addition to these obstacles single-payer still isn’t especially popular. It still doesn’t poll above 50%. A CBS poll had it at 44% in February and a Pew research poll had it at 33% last week. These results are without a concerted negative campaign by the right which isn’t necessary for now.
So, Liberals keep on believing. Just snap your heels together three times and keep repeating there’s no place like single payer, there’s no place like single payer, that’ll get it done.
I’ll keep hoping Trumpcare fails and Republicans and Democrats come together to keep and repair Obamacare.
So, for the sake of argument what’s it going to take to pass single-payer. Well, you need a President who is willing to sign it or two thirds of the House to override a veto (that’s 290 seats and Democrats currently hold 193). So, we need a President, and a majority in the House, 25 seats gets us there. We’ll need 60 votes in the Senate to overcome a filibuster, that’s a pickup of twelve senators, and we will need 5 votes in the Supreme Court to overcome the inevitable court challenge. It isn’t necessary but it would be nice to have control of more states to help with implementation, Democrats currently control 13 states. So, as you can see it is a pretty big climb to the top of single-payer mountain.
In addition to these obstacles single-payer still isn’t especially popular. It still doesn’t poll above 50%. A CBS poll had it at 44% in February and a Pew research poll had it at 33% last week. These results are without a concerted negative campaign by the right which isn’t necessary for now.
So, Liberals keep on believing. Just snap your heels together three times and keep repeating there’s no place like single payer, there’s no place like single payer, that’ll get it done.
I’ll keep hoping Trumpcare fails and Republicans and Democrats come together to keep and repair Obamacare.
1
Those poll numbers can be changed. In fact they are probably not accurate since people don't know what single payer is or does. If you asked them about Medicare (which they understand and love) for all, the results would probably be similar to what they were in October 2003, when a Washington Post poll found that 62% supported "a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers.
5
It would still be Obamacare? Did you forget who your Republican president is?
4
Obamacare was poorly designed and made certain assumptions on population behavior which turned out not to be true. And this is what is causing the problem today. What do we do about assumptions that were not true?
There has to be serious thought given to scaling back parts of law to make them more compatible with the budget. We are running too large a deficit to keep spending like a drunken sailor and think we can continue to put everything on the national credit card. Those days are over.
That mean slimming down Obamacare and reining in the areas which have the largest impact on the budget. That means slimming down Medicaid which is already in trouble. I think creating the expansion was a big mistake since it is optional and not every states wants the expense it will entail as government contributions decrease over time. Of course when it was created, Obama and the Dems thought the expansion would be compulsory, but it didn't turn out that way. It is probably the Expansion that will have to undergo the largest cuts.
I think it would be better if only ONE change was made. A single change will be easier to get through Congress than one great big overhaul package. Congress should only work on slimming down the Expansion and perhaps the CMS list of mandatory inclusions in all insurance. Iinstead of insisting everything be in one policy, they could let the insurance company divide them into multiple policies which might cover different things at different costs.
There has to be serious thought given to scaling back parts of law to make them more compatible with the budget. We are running too large a deficit to keep spending like a drunken sailor and think we can continue to put everything on the national credit card. Those days are over.
That mean slimming down Obamacare and reining in the areas which have the largest impact on the budget. That means slimming down Medicaid which is already in trouble. I think creating the expansion was a big mistake since it is optional and not every states wants the expense it will entail as government contributions decrease over time. Of course when it was created, Obama and the Dems thought the expansion would be compulsory, but it didn't turn out that way. It is probably the Expansion that will have to undergo the largest cuts.
I think it would be better if only ONE change was made. A single change will be easier to get through Congress than one great big overhaul package. Congress should only work on slimming down the Expansion and perhaps the CMS list of mandatory inclusions in all insurance. Iinstead of insisting everything be in one policy, they could let the insurance company divide them into multiple policies which might cover different things at different costs.
Deficit! Republicans don't care about deficits. Did you see tax reform plan?
6
It seems to me that the most important thing that could be done is to educate the voters is to get them to understand the facts, the data. For example:
They have to realize that the finances of a huge long lived country that can create as much money as it needs and MUST create the money we need to conduct commerce are far, far different from the personal finances they discuss around the kitchen table. They must learn that ALL 6 times we have been "financially responsible" and eliminated federal deficits for a while and paid down the debt by 10% or more, this period has been immediately followed by one of the 6 terrible depressions the country has suffered thru. The fact that most people do not understand this is perhaps the greatest problem facing the country.
Furthermore the public debt ration was 47% higher in 1946 and that was followed by 27 years of Great Prosperity as well as mostly deficit spending that increased the debt in dollars 75%.
On the other hand after WWI we had 10 years with no deficits and decreased the debt by almost 40%. The debt ratio was only 16% in October of 1929.
AND THEN WHAT HAPPENED?
They have to realize that the finances of a huge long lived country that can create as much money as it needs and MUST create the money we need to conduct commerce are far, far different from the personal finances they discuss around the kitchen table. They must learn that ALL 6 times we have been "financially responsible" and eliminated federal deficits for a while and paid down the debt by 10% or more, this period has been immediately followed by one of the 6 terrible depressions the country has suffered thru. The fact that most people do not understand this is perhaps the greatest problem facing the country.
Furthermore the public debt ration was 47% higher in 1946 and that was followed by 27 years of Great Prosperity as well as mostly deficit spending that increased the debt in dollars 75%.
On the other hand after WWI we had 10 years with no deficits and decreased the debt by almost 40%. The debt ratio was only 16% in October of 1929.
AND THEN WHAT HAPPENED?
6
There's nothing here that addresses the main problem people have with Obamacare: the premiums are too high. Instead, Douthat calls for repealing the individual mandate, which will cause premiums to skyrocket. How are voters going to feel about the Republicans when they see that their modest reform has caused a death spiral in the individual market?
17
Read https://www.forbes.com/sites/robbmandelbaum/2017/02/24/no-obamacare-hasn...
The ACA was responsible for LOWER premiums than we would have without it.
The ACA was responsible for LOWER premiums than we would have without it.
5
please don't propose a penalty which ought not to be imposed on those foolish or young enough to deny the possibility of a catastrophic injury or illness - universal health care is the simple solution - eliminate billionaire health executives - cut administrative and overhead cost to providers - let's be civilized, compassionate and smart - no one loses when we all have access to medical care and learn to avoid life style choices which make us ill - spend money on recreation! reinstate recess! no food deserts.
6
Everyone is missing the most important change to healthcare in the new Republican proposal. It eliminates all penalties for all employers, even very large employers, who decide to no longer provide health insurance. If passed, this will cause huge numbers of employers to end health insurance for their employees. All of a sudden, millions of workers who have not been affected by the ACA will find that (a) their untaxed health insurance benefit will be gone, (b) they will now need to enter the awful Obamacare market to buy health insurance, and (c) they will be paying for the insurance with after tax dollars.
Why hasn't there been more discussion of this crucial change?
Why hasn't there been more discussion of this crucial change?
43
This comment should be a NYTimes Pick. Dropping the individual mandate with an obvious-enough reason to opt in (like you are stuck with no affordable insurance for some period) will probably produce no greater adverse selection than the mild tax penalty faced by an invidual mandate-avoider. Eliminating the employer mandate will lead to genuine hardship and suffering. I've noticed that both Douthat and Stephens are light on their understanding of some of the crucial healthcare issues at stake as well as healthcare economics. NYTimes columnists really should do better.
5
Translation: republicans are not capable to govern.
11
Solution: Medicare for all, with the government permitted to negotiate drug prices. Pay for it by soaking the rich, who don't have numbers to exact revenge in the voting booth. What could be simpler and less politically dangerous?
40
How many people losing access to healthcare would be acceptable to Douthat? Would 15 million be okay, 10 or maybe five? Does everything boil down to what the Republican Party can campaign on?
44
Not many. Just his immediate family. Not many. Just those he loves most. Many. While he doesn't know them personally.
Or even better, ask him how many unnecessary deaths are acceptable?
We all pay taxes for all kinds of unnecessary things that some of us never need and never use. Why is the republican line in the sand being drawn on tax for health care which most people will need at some point in their lives. I rather see other services get cut than affordable healthcare for everyone. Many Americans would agree with me I believe.
37
We are faced witn unaffordable insurance and healthcare because medical inflation has outstripped regular inflation for years. Capping Medicaid does nothing to change this, thus, one can expect the result of capping Medicaid will be people without any form of health insurance. Exactly what the ACA was designed to fix.
The only advantage such a program would have is that the Medicaid caps would squeeze people out of the program slowly, thus allowing the GOP to avoid the political consequences of throwing the sick under the bus.
The only advantage such a program would have is that the Medicaid caps would squeeze people out of the program slowly, thus allowing the GOP to avoid the political consequences of throwing the sick under the bus.
15
Mandating what should be covered and mandating insurance is not insurance it is merely determining who wins and loses. To correct the mess (Obamacare and the GOP plan) offer a continuation of Obamacare to all who currently have it or wish to have it. Determine the cost of the existing benefit and offer it in cash to any one
who qualifies. I am certain that a huge majority would take the cash and get their own insurance. Unnecessary
Medical services would plummet and hopefully costs would be contained.
who qualifies. I am certain that a huge majority would take the cash and get their own insurance. Unnecessary
Medical services would plummet and hopefully costs would be contained.
2
A solution to improving our health outcomes and managing our costs will not fit on a bumper sticker and will not fit in a NY Times column. As the President and his party discovered recently (when the barking dog finally and unexpectedly caught the car), this is a highly complex issue - all the more so when we abjure Single Payer due to entrenched interests.
Even young healthy people risk getting sick or injured. This is why everyone should have some minimal insurance coverage. Trump ruled out "people dying in the streets" so we will treat everyone who needs emergency treatment. No one is immune from life's vicissitudes.
Setting the minimum acceptable level of insurance can be a subject for debate, but allowing "junk insurance" or gaps in coverage when someone loses a job or any number of other so-called solutions is simplistic to a fault. Have people forgotten what an unholy mess this was - with exactly those sorts of flaws - before Obamacare?
This is complicated stuff. Having dysfunctional political warfare has allowed or even encouraged the ACA's shortcomings to fail to provide a solution. Maybe Single Payer is the path forward, but no one should think that will bean easy or perfect solution either. Building an American model will require diligence and compromise and practical thinking replacing ideology.
Right now, we seem woefully unprepared to be serious.
Even young healthy people risk getting sick or injured. This is why everyone should have some minimal insurance coverage. Trump ruled out "people dying in the streets" so we will treat everyone who needs emergency treatment. No one is immune from life's vicissitudes.
Setting the minimum acceptable level of insurance can be a subject for debate, but allowing "junk insurance" or gaps in coverage when someone loses a job or any number of other so-called solutions is simplistic to a fault. Have people forgotten what an unholy mess this was - with exactly those sorts of flaws - before Obamacare?
This is complicated stuff. Having dysfunctional political warfare has allowed or even encouraged the ACA's shortcomings to fail to provide a solution. Maybe Single Payer is the path forward, but no one should think that will bean easy or perfect solution either. Building an American model will require diligence and compromise and practical thinking replacing ideology.
Right now, we seem woefully unprepared to be serious.
32
I so appreciate what you have written. As one who participated in studies in my state starting in the early 1990's, then onto the Clinton years, then onto the Obama years, it is the complexity, the lack of needed understanding of the issue, how insurance works, how the employer issue muddies the waters, and you are fully aware of the other rough waters.
I thank you.
I thank you.
Ross, This is a sensible Health Care proposal.
Politically it doesn't have a chance. Your plan does not include the 3.8% tax cut on investment income for the top 1%--which is the primary goal of the traditional Republicans (Ryan and friends--fiends). And it doesn't eliminate subsidies for low income people to buy insurance or strangle Medicaid--which is the goal of extreme right. So 50 Republican votes--no way.
Politically it doesn't have a chance. Your plan does not include the 3.8% tax cut on investment income for the top 1%--which is the primary goal of the traditional Republicans (Ryan and friends--fiends). And it doesn't eliminate subsidies for low income people to buy insurance or strangle Medicaid--which is the goal of extreme right. So 50 Republican votes--no way.
6
"True, eliminating the mandate would lead to less coverage."
That one line stopped me cold! We happen to be talking about people's lives, not some legislation about some ambiguous tax reform. This is a life and death issue for our fellow citizens.
The Democrats lost the House because of the constant stream of negativity from the Republicans about the ACA. But you know what, it's okay, because President Obama and under the leadership of Nancy Pelosi they made available a health insurance plan to 20 million that didn't have anything before that, and expanded Medicaid services to millions more.
I'm just thankful for being a Democrat. It's a good feeling to know you're on the right side of history. Social Security, Medicare, Medicaid, and the Affordable Care Act, all from Democratic Administrations.
That one line stopped me cold! We happen to be talking about people's lives, not some legislation about some ambiguous tax reform. This is a life and death issue for our fellow citizens.
The Democrats lost the House because of the constant stream of negativity from the Republicans about the ACA. But you know what, it's okay, because President Obama and under the leadership of Nancy Pelosi they made available a health insurance plan to 20 million that didn't have anything before that, and expanded Medicaid services to millions more.
I'm just thankful for being a Democrat. It's a good feeling to know you're on the right side of history. Social Security, Medicare, Medicaid, and the Affordable Care Act, all from Democratic Administrations.
247
And minimum wage, child labor restrictions, 40-hour workweek, worker's protections, Family and Medical Leave, etc. I fact, no Republican policy or legislation has improved the human condition in this country in almost 60 years. Why the "disenfranchised working class" switched from voting their own interests to voting for their own deaths is a credit to the lies of Ronald Reagan - you can have the greatest country in the world without paying taxes. You can't, and you don't. Yet ignorant working class fools send their Republican executioners back to congress year after year. Any intelligent discussion of a real policy, like healthcare and health insurance, thus ends there. The republican base is just incapable of intelligent discussion.
Yes and guess what happened at the Supreme Court to the Medicaid Expansion?
How many states decided the Expansion was too expensive. And what about the cost of illegal aliens? You know instead of deporting them when they show up at the ER, we allow them to get continuous treatment for expensive procedures like Organ transplants, Cancer, Kidney Failure etc. When we should be deporting them back to their home country to receive medical treatment.
How many states decided the Expansion was too expensive. And what about the cost of illegal aliens? You know instead of deporting them when they show up at the ER, we allow them to get continuous treatment for expensive procedures like Organ transplants, Cancer, Kidney Failure etc. When we should be deporting them back to their home country to receive medical treatment.
Imagine I paid for EVERYONE'S health care.
Now imagine that because I pay all the bills I get to dictate my terms to the providers and the pharmaceutical makers.
Because I represent the market I get to control costs.
Now imagine the rest of the civilized world delivers health care this way.
OOPS, no imagination required. It's a fact !
Let's be civilized.....
Now imagine that because I pay all the bills I get to dictate my terms to the providers and the pharmaceutical makers.
Because I represent the market I get to control costs.
Now imagine the rest of the civilized world delivers health care this way.
OOPS, no imagination required. It's a fact !
Let's be civilized.....
111
As the last presidential election proved, this country isn't even ready for civilization's bike with training wheels.
1
"Benefit only the Republican party's donors" indeed. Why else would a Senator or House member take the risk of repealing the ACA without making sure the knots in the safety net are tied!
4
Although I would be adversely impacted by the Senate Bill to repeal and replace the ACA, I really want the Republicans to walk this plank over the edge and pay the ultimate political price in 2018 and 2020.
This Bill serves only their donors and the people that actually elected Trump will be hurt badly by this bill. Unfortunately, I believe that they need to see with their own eyes that they have been misled and that supporting a billionaire to be the president was a mistake that even the most ardent Trump supporter won't be able to deny.
They are so obsessed with being Anti, Anti Trump that they can't see the truth of how this legislation will negatively impact them and tough love is in order.
This Bill serves only their donors and the people that actually elected Trump will be hurt badly by this bill. Unfortunately, I believe that they need to see with their own eyes that they have been misled and that supporting a billionaire to be the president was a mistake that even the most ardent Trump supporter won't be able to deny.
They are so obsessed with being Anti, Anti Trump that they can't see the truth of how this legislation will negatively impact them and tough love is in order.
11
"The Democrats in 2010 were on the cusp of achieving their decades-old health care policy dream"
No, not actually. In January 1971, Ted Kennedy introduced a bipartisan Kennedy-Griffiths bill proposing universal national health insurance. Richard Nixon responded by proposing more limited reform that was essentially more progressive than the ACA, but Kennedy balked because he thought much more would soon be possible.
Since then the investments of a billion dollars by the Koch Bros alone and much more from other right wing plutocrats, buying influence, strategy and the creation and dispersal of propaganda has helped turn the Republican party to the extreme right.
I sincerely doubt that the ACA fulfilled Obama's dream, he even tried to include a single payer option but it was blocked by Lieberman (please readers, never forgive that man for this betrayal).
Democrats need to exploit this current Republican humiliation and stand up for Medicare for Americans of all ages unequivocally.
No, not actually. In January 1971, Ted Kennedy introduced a bipartisan Kennedy-Griffiths bill proposing universal national health insurance. Richard Nixon responded by proposing more limited reform that was essentially more progressive than the ACA, but Kennedy balked because he thought much more would soon be possible.
Since then the investments of a billion dollars by the Koch Bros alone and much more from other right wing plutocrats, buying influence, strategy and the creation and dispersal of propaganda has helped turn the Republican party to the extreme right.
I sincerely doubt that the ACA fulfilled Obama's dream, he even tried to include a single payer option but it was blocked by Lieberman (please readers, never forgive that man for this betrayal).
Democrats need to exploit this current Republican humiliation and stand up for Medicare for Americans of all ages unequivocally.
211
I'd like to see the evidence that repealing the taxes on medications and medical devices would result in cost savings for consumers. As Mr. Shkreli so ably demonstrated, prescription medicine prices have little relationship to supply and demand. Much medical hardware costs twice as much or more in the US as it does in Europe. I'm not aware of orthopedists asking their patients if they want the $12,000 hip prosthesis or the $10,000 one, or cardiologists asking if they want the $20,000 heart valve or the $20,500 one. The companies are price gouging. It seems just as likely to me that any tax savings will be passed on to investors in increased profits rather than rebated to the consumer.
248
Ross, conservatives should cease thinking entirely, inasmuch as forging successful policies is clearly not their strength, and instead simply ape what other advanced industrial nations have done to save money on healthcare.
Stop imagining yourselves policy wonks, start copying elements of systems that already work well, and save taxpayers' money - TREMENDOUS AMOUNTS OF MONEY.
Copy the Swiss, the Germans, the Brits, the Japanese, the Canadians, the French, etc., all of whom cover everyone at a fraction of what we spend.
Our leaders were once exceptional but today - especially on your side of the political divide - they're mostly ordinary, if not embarrassing (as in the instance of our Tweeter-in-Chief).
Ross, if the truth be told, healthcare policy is way beyond the conservative political establishment's pay grade. If the ACA doesn't work - and I'm no fan of it - then blame the Heritage Foundation for originally envisioning this Rube Goldberg contraption, and hang up the phone next time they call you with an idea.
Only ideology-obsessed conservatives would attempt to reinvent the wheel, in the process guaranteeing that everyone but the Koch Brothers and their high-net worth brethren, end up in a ditch.
Stop imagining yourselves policy wonks, start copying elements of systems that already work well, and save taxpayers' money - TREMENDOUS AMOUNTS OF MONEY.
Copy the Swiss, the Germans, the Brits, the Japanese, the Canadians, the French, etc., all of whom cover everyone at a fraction of what we spend.
Our leaders were once exceptional but today - especially on your side of the political divide - they're mostly ordinary, if not embarrassing (as in the instance of our Tweeter-in-Chief).
Ross, if the truth be told, healthcare policy is way beyond the conservative political establishment's pay grade. If the ACA doesn't work - and I'm no fan of it - then blame the Heritage Foundation for originally envisioning this Rube Goldberg contraption, and hang up the phone next time they call you with an idea.
Only ideology-obsessed conservatives would attempt to reinvent the wheel, in the process guaranteeing that everyone but the Koch Brothers and their high-net worth brethren, end up in a ditch.
336
In the hundred and thirty years since that noted Bolshevik Otto von Bismark instituted government sponsored health care in Prussia, a cost effective "free enterprise" medical health care system has been as ubiquitous as a unicorn. It has never worked anywhere, If it is was doable it would have already been done.
1
See see this piece by Eric Hobsbawm in the London Review of Books for another view of American leaders, presidents in particular:
https://www.lrb.co.uk/v13/n10/eric-hobsbawm/what-difference-did-she-make...
https://www.lrb.co.uk/v13/n10/eric-hobsbawm/what-difference-did-she-make...
1
Neither the Republicans nor Trump have an actual public health care plan that would cover everyone, cheaper, and better! They aren't "too divided on health care"; they are united: destroy public health care. That's it. That and more tax cuts and breaks for their corporate sponsors and the rich.
The once Grand Old Party of Lincoln, Teddy Roosevelt, and Eisenhower has become the party of Don't Care for Health Care; but do Care for Tax Cuts for themselves. The rest of us can just take a hike to nowhere.
The once Grand Old Party of Lincoln, Teddy Roosevelt, and Eisenhower has become the party of Don't Care for Health Care; but do Care for Tax Cuts for themselves. The rest of us can just take a hike to nowhere.
68
Mr. Ross, you missed the boat on this one. The efforts of the GOP in regards to health care reform are:
1) Erase everything President Obama did.
2) Provide a big tax cut fro their donors.
That's it.
As far as your plan is concerned, best you earn a living writing editorials and not legislation.
1) Erase everything President Obama did.
2) Provide a big tax cut fro their donors.
That's it.
As far as your plan is concerned, best you earn a living writing editorials and not legislation.
532
How is it possible that WE THE TAX PAYERS are forced to pay for these republican lawmakers (and their families) PREMIUM health care FOR LIFE...and yet THEY get to decide IF WE EVEN HAVE ANY???
Why isn't that the ONLY talking point moving forward with their debate?
Why isn't that the ONLY talking point moving forward with their debate?
3
Here's the thing: Republicans have an unquenchable urge for destroying the Obama legacy. The concept of a black President is anathema to them; it's in their DNA. There, I said it. Never mind that millions more are now insured, lifetime caps are gone and pre-existing conditions are no longer disqualifying. The biological imperative of the GOP remains - and it is useless to offer reasonable solutions and fixes.
And Democrats are not blameless either. Legislators of both parties refuse to let Uncle Sam negotiate with big pharma. Why? Follow the money straight from big pharma to Congress. The rest of the developed world pays much lower prices for prescription drugs because their legislators and regulators represent citizens, not big pharma.
And while I'm at it, why not a single payer, like Medicare for everyone? Again, it's about money which flows from insurers straight to Congress.
Everyone (except greedy politicians and the medical insurance/pharma complex) wins when people are healthy. Medicare works for seniors; it can work for all of us.
And Democrats are not blameless either. Legislators of both parties refuse to let Uncle Sam negotiate with big pharma. Why? Follow the money straight from big pharma to Congress. The rest of the developed world pays much lower prices for prescription drugs because their legislators and regulators represent citizens, not big pharma.
And while I'm at it, why not a single payer, like Medicare for everyone? Again, it's about money which flows from insurers straight to Congress.
Everyone (except greedy politicians and the medical insurance/pharma complex) wins when people are healthy. Medicare works for seniors; it can work for all of us.
111
A That is one great post. You said what needs to be said. We, the little, people have been had. Follow the money.
It's telling that too many of today's discussions of health care in America center on political strategy and not on health. Most of those discussions are by people whose health care coverage is just fine. They find it too difficult to even imagine a discussion that puts health and human beings first, even though every other advanced nation figured out how to do that a long time ago. And so we slide ever downward, abandoning humanity in favor of "tax reform" and midterm election victories. Trump's cruelty is just the outward manifestation of a nation full of people who should care and don't. They have other concerns.
41
"There are no underprivileged Libertarians."
W C Devins, 2001
W C Devins, 2001
1
Going small on health care? Compared to what, when, why, where and who?
Anything less than single payer health care as a universal humble humane empathetic American civilized divine natural equal certain unalienable right that is essential to life, liberty and the pursuit of happiness is going way too small.
Anything less than single payer health care as a universal humble humane empathetic American civilized divine natural equal certain unalienable right that is essential to life, liberty and the pursuit of happiness is going way too small.
153
Things were a lot simpler in Thomas Jefferson's time. No need to put health care in the Declaration of Independence thanks to our relatively short life spans in the 18th century. That's why the minimum age to qualify for the presidency in the Constitution was set at 35. Today 35 seems incredibly young. However, back then 35 was the equivalent of today's 55. Sorry but health care is not an unalienable right which guarantees life, liberty and the pursuit of happiness. Come to think of it you're "entitled" to absolutely nothing.
3
Sharon- We are the government and we can decide where we want our money spent. Nothing in the Constitution prohibits the government from deciding what our tax dollars are spent on. If we want to interpret the preamble of the Constitution where it states "We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, PROMOTE THE GENERAL WELFARE, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of ..." means we can provide through our tax dollars access to healthcare, education, food, a safe work environment as a general interpretation of promoting the general welfare of our citizenry. The Constitution does not prohibit us from doing these things. The Constitution does not prohibit the use of tax money to promote the general welfare of the residents of the United States. Why is that so difficult to understand?
12
Why is health care an inalienable right for the politicians, and why is it subsidized to approx. 75% with OUR TAX DOLLARS, while they can tell US to drop dead?
4
The GOP decided before Obama ever took office that they would not work with him. No matter what Obama said or did, no matter how many overtures he made to them, their response was the same: a complete refusal to work with a duly elected president. The ACA was based on a Republican idea. The GOP didn't like it. Why? Because Obama proposed it. The reason they want to repeal it rather than tweak it is because they don't want Americans to have access to health care when and where they need it. The GOP owns this now and if they prefer to leave Americans vulnerable to medical bankruptcy, premature death, unhealthy lives, formerly conquered illnesses and complications they will. If the Democrats are smart they will start every speech with a reference to how many people are suffering due to a lack of affordable accessible health care. Furthermore, the Democrats will tell the people in their ranks who want to subsidize the wealth care industry that this industry is one of the biggest obstacles to reform and guaranteed access to the medical care Americans need.
Other countries decided that health care is a right. Only in America do we continue with the lie and scam that health insurance coverage equals access to health care. All we're doing is taking care of their health while they destroy ours. But neither party will be bold enough to do the right thing and create a real health care system that works for Americans rather than the wealth care industry of America.
Other countries decided that health care is a right. Only in America do we continue with the lie and scam that health insurance coverage equals access to health care. All we're doing is taking care of their health while they destroy ours. But neither party will be bold enough to do the right thing and create a real health care system that works for Americans rather than the wealth care industry of America.
141
If Republicans were compassionate, concerned about health care for all of our citizens and actually worked for the best interests of people rather than their personal portfolios, they’d be Democrats.
Not that the Democrats are perfect. They’re just not so blatantly motivated by greed in the service of cruelty to the old, the poor and the sick. They’re the ones raising the alarm against the closed-door machinations of Republicans, who are being whipped by the president to do something, anything to uphold the appearance of Republican legitimacy.
But legitimacy has left the building. Their only goal is to replace Obama’s legacy in effigy by replacing Obamacare. It’s all the G.O.P. Obamacares about.
The Affordable Care Act was a novel idea, and even its proponents knew that it would require mid-course corrections along the way. But the idea of tweaking Obama’s legacy would only make it look better in retrospect, and done so by the hands of Republicans. There could never be too many deaths or untreated illnesses among the hoi-polloi to justify that.
We should remember that Mitt Romney, a Republican who made Romneycare work in Massachusetts, thought that half the country was made up of moochers and takers. It’s that sort of attitude that makes Republicans unable to implement any plan that treats them like worthwhile human beings.
If any G.O.P. plan appears to work for the people, it's only because we haven't found the gotchas that are surely hidden within.
Not that the Democrats are perfect. They’re just not so blatantly motivated by greed in the service of cruelty to the old, the poor and the sick. They’re the ones raising the alarm against the closed-door machinations of Republicans, who are being whipped by the president to do something, anything to uphold the appearance of Republican legitimacy.
But legitimacy has left the building. Their only goal is to replace Obama’s legacy in effigy by replacing Obamacare. It’s all the G.O.P. Obamacares about.
The Affordable Care Act was a novel idea, and even its proponents knew that it would require mid-course corrections along the way. But the idea of tweaking Obama’s legacy would only make it look better in retrospect, and done so by the hands of Republicans. There could never be too many deaths or untreated illnesses among the hoi-polloi to justify that.
We should remember that Mitt Romney, a Republican who made Romneycare work in Massachusetts, thought that half the country was made up of moochers and takers. It’s that sort of attitude that makes Republicans unable to implement any plan that treats them like worthwhile human beings.
If any G.O.P. plan appears to work for the people, it's only because we haven't found the gotchas that are surely hidden within.
184
As a consumer healthcare advocate, I give this POV an E for Effort and and M for Missing the Boat.
One of the key propositions the GOP leadership is super glued to is the idea of allowing insurers to decide what tests/procedures/drugs/devices to cover in their plans. (States that care and can act might affect this, but not many if any).
The ACA, as we know, had a list of items that must be covered in order to be considered a ACA-worthy plan. It also had a list of free preventative tests and procedures that were required. It made the mandate make sense, as the policies pre-ACA weren't worthy of lining a bird cage. The biggest failing was that for 7 years, the GOP obstructed any effort to close ACA loopholes and regulate the price gouging that was occurring at the hands of insurers, healthcare providers and pharmaceutical companies.
If we don't have minimum coverage requirements, and we don't have mandates, we open the door to Uncle Fred selling $30 per month worthless policies out of his garage (provided he's licensed, of course). Smart Americans will get worthless policies that cost almost nothing to keep them out of the 6 month penalty for a 63 day delay in coverage. Then, if they actually do need serious medical attention, they'll switch policies and get a pseudo reputable plan from one of the big insurance sharks.
The GOP is so busy trying to game the system that they don't understand those of us with boots on the ground know how to game their weak efforts.
One of the key propositions the GOP leadership is super glued to is the idea of allowing insurers to decide what tests/procedures/drugs/devices to cover in their plans. (States that care and can act might affect this, but not many if any).
The ACA, as we know, had a list of items that must be covered in order to be considered a ACA-worthy plan. It also had a list of free preventative tests and procedures that were required. It made the mandate make sense, as the policies pre-ACA weren't worthy of lining a bird cage. The biggest failing was that for 7 years, the GOP obstructed any effort to close ACA loopholes and regulate the price gouging that was occurring at the hands of insurers, healthcare providers and pharmaceutical companies.
If we don't have minimum coverage requirements, and we don't have mandates, we open the door to Uncle Fred selling $30 per month worthless policies out of his garage (provided he's licensed, of course). Smart Americans will get worthless policies that cost almost nothing to keep them out of the 6 month penalty for a 63 day delay in coverage. Then, if they actually do need serious medical attention, they'll switch policies and get a pseudo reputable plan from one of the big insurance sharks.
The GOP is so busy trying to game the system that they don't understand those of us with boots on the ground know how to game their weak efforts.
419
Thank you for weighing in on these discussions, Sarah.
Your perspective from the healthcare field is invaluable.
Your perspective from the healthcare field is invaluable.
19
Ms. O'Leary,
Thank you for continuing to provide your expertise and perspective. It is very much needed, and appreciated.
Thank you for continuing to provide your expertise and perspective. It is very much needed, and appreciated.
8
Right and here are some further points.
There are many aspects of the Senate bill that are hidden away, but can be very disastrous, You can find some in https://www.brookings.edu/blog/up-front/2017/06/23/changes-to-state-inno...
For examples, you may know that under this bill states will be able to ask for waivers to allow yearly and lifetime limits on insurance claims, thus letting really sick people die. You may also know that states may ask for waivers on coverage such as maternity benefits.
But do you know that previously states were required to show that the waivers do not reduce coverage, i.e. that patients will be able to get coverage somewhere else such as state plans, and the HEW Sec. had some discretion as to whether or nor to grant the waivers. Under the Senate bill, if the state can simply show the waivers will save insurance companies money, the waiver MUST be granted.
Also if one state gets lots of bad waivers, the insurance companies can base all their plans in that state, but still offer them nationally. The situation will be like credit cards where Citibank bribed SD to relax their usury laws and most credit card companies moved to SD.
There are many aspects of the Senate bill that are hidden away, but can be very disastrous, You can find some in https://www.brookings.edu/blog/up-front/2017/06/23/changes-to-state-inno...
For examples, you may know that under this bill states will be able to ask for waivers to allow yearly and lifetime limits on insurance claims, thus letting really sick people die. You may also know that states may ask for waivers on coverage such as maternity benefits.
But do you know that previously states were required to show that the waivers do not reduce coverage, i.e. that patients will be able to get coverage somewhere else such as state plans, and the HEW Sec. had some discretion as to whether or nor to grant the waivers. Under the Senate bill, if the state can simply show the waivers will save insurance companies money, the waiver MUST be granted.
Also if one state gets lots of bad waivers, the insurance companies can base all their plans in that state, but still offer them nationally. The situation will be like credit cards where Citibank bribed SD to relax their usury laws and most credit card companies moved to SD.
Let me sell you and your "let the market fix it" buddies a clue: There's no money to be had from the sick, the elderly and the poor when it comes to health insurance. It's why Medicare and Medicaid work for millions of Americans.
What is your objective, sir? Profits and tax cuts for the rich or health care for Americans? That's the choice.
What is your objective, sir? Profits and tax cuts for the rich or health care for Americans? That's the choice.
685
Most of us know there's no money to be had from the sick and poor in health care. The question is why the party that pushes a high profit health system that exploits us, has been able to take over our 3 branches, and many state govts.
And why even the opposing party can't protect we the people, but simply passes Republican lite health care that expand the insured but leaves out millions, and props up insurance profits with our taxes?
Our politics is an investemnt for profit by large corporations, all legalized as 'free corporate speech' by our highest court.
Where are the columnists to start analyzing the cause and effect, so we don't have to fight this battle 20 years from now?
And why even the opposing party can't protect we the people, but simply passes Republican lite health care that expand the insured but leaves out millions, and props up insurance profits with our taxes?
Our politics is an investemnt for profit by large corporations, all legalized as 'free corporate speech' by our highest court.
Where are the columnists to start analyzing the cause and effect, so we don't have to fight this battle 20 years from now?
7
This member of "us the people" is deeply grateful to the opposing party for my individual ACA policy, which lets me keep glaucoma from destroying my vision. Kindly remember that Republican governors refusing the Medicaid expansion are what "left out millions."
Call the PPACA "Republican Lite" all you want, but it changed the public's expectation about access to insurance coverage and medical care even in states like Ohio and Kentucky. Sure beats having my optic nerves deteriorate while we push for single-payer and the end of Citizens United. I appreciate politicians who accomplish the possible while working toward the ideal.
Call the PPACA "Republican Lite" all you want, but it changed the public's expectation about access to insurance coverage and medical care even in states like Ohio and Kentucky. Sure beats having my optic nerves deteriorate while we push for single-payer and the end of Citizens United. I appreciate politicians who accomplish the possible while working toward the ideal.
9
I have heard the expression "the penalty box" only once or twice since this debate began in the Senate. It refers to the time an insurer needs to wait for coverage if they don't sign on immediately. I understand this is a six month waiting period? Visually strong statement. Great meathaphor. Why then is it not used as the Republicans used the "death panel" to go against Obamacara. Is there no discipline in the Democratic Party? Didn't think so.
Listen to Bernie. Listen to Liz Warren. No, they are NOT fringe. They are genuine and they really care.
233
Bernie Sanders and LIz Warren are NOT the fringe? Yet they are treated as such in our media. They'd be centrist abroad. Not only are they genuine, instead of hypocrites, their ideas work in other nations.
Sanders simply pushed a health system that's used by many other capitalist democracies. For this he was dissed and sidelined.
The various plans working abroad for generations are still not explained in our media and the Times. Even their liberal columnists avoid it. It's the heart of the biggest issue of our time. But they get much more mileage from just lambasting Trump and Gop, then in an evidenced based discussion about what works, with data from all over the world.
They neglect the press's role to inform the public in a democacy, and for this they get excellent health insurance from their jobs with the Times, that they can well afford!
Sanders simply pushed a health system that's used by many other capitalist democracies. For this he was dissed and sidelined.
The various plans working abroad for generations are still not explained in our media and the Times. Even their liberal columnists avoid it. It's the heart of the biggest issue of our time. But they get much more mileage from just lambasting Trump and Gop, then in an evidenced based discussion about what works, with data from all over the world.
They neglect the press's role to inform the public in a democacy, and for this they get excellent health insurance from their jobs with the Times, that they can well afford!
16
Can we PLEASE stop tying universal health care to specific politicians? The goal is to push ALL our politicians and society as a whole toward seeing health care as a human right. It doesn't matter who carries the ball forward, and universal care has long been a Democratic Party goal. Two decades ago, it was Hillary Clinton trying to push that boulder uphill, same as Bernie and Liz today This fight began with Teddy Roosevelt, not with Liz and Bernie.
Also, the virtues of single-payer in other nations are politically irrelevant here, unless you think Bernie and Liz can magically vaporize our massive 70-year-old legacy system and the insurance giants it spawned. We have to deal with the reality in front of us -- that any change will have to be incremental and include them. Short of nuclear holocaust, they're not just going to throw down their spreadsheets and walk into the sea so we can start from scratch. Bernie lays out good goals, but no practical map for getting from here to there.
I want universal coverage. But I do not rest my hopes on any individual leader, nor any particular plan. The centuries-old battle for racial equality did not began with Martin Luther Kng; neither did his death end it. Likewise, the fight for universal healthcare is too important to be tied to any particular spokesperson or political label. It must become...universal.
Also, the virtues of single-payer in other nations are politically irrelevant here, unless you think Bernie and Liz can magically vaporize our massive 70-year-old legacy system and the insurance giants it spawned. We have to deal with the reality in front of us -- that any change will have to be incremental and include them. Short of nuclear holocaust, they're not just going to throw down their spreadsheets and walk into the sea so we can start from scratch. Bernie lays out good goals, but no practical map for getting from here to there.
I want universal coverage. But I do not rest my hopes on any individual leader, nor any particular plan. The centuries-old battle for racial equality did not began with Martin Luther Kng; neither did his death end it. Likewise, the fight for universal healthcare is too important to be tied to any particular spokesperson or political label. It must become...universal.
2
Amongst the entire GOP, they don't have the two superb brains that Bernie Sanders and Elizabeth Warren have...and amongst the entire GOP, they don't have the two moral, compassionate hearts that Bernie Sanders and Elizabeth Warren have.
It is like comparing Charles Manson with Mother Teresa.
It is like comparing Charles Manson with Mother Teresa.
4
How about this as a modest proposal:
Stop calling it Obamacare, it wasn't his idea, it was borrowed (plaigiarized, if you like) from the Heritage Foundation. The "individual mandate" was their idea, so that there would be "no free riders." Governor Romney instituted such a system in Massachusetts.
It's a Republican plan, designed to keep insurance companies in the game by providing people who otherwise couldn't afford adequate insurance with subsidies, turning them into millions of new customers.
"Obamacare" IS the Republican health plan. The reason they can't find a "replacement" is that it is already in place. You Republicans should own it, and take credit for its successes.
And for my friend with kidney disease who was able to buy insurance and whose life was saved by Obamacare, for those of us whose first-time health insurance let them get tested for dangerous things that are now prevented, and for the millions of babies born with good prenatal care because of Medicaid and who were too young to make rational choices between the inadequate plans the Republicans today are proposing -- we'd all be grateful to you. Republicans would get a lot of thanks. Think about it.
Stop calling it Obamacare, it wasn't his idea, it was borrowed (plaigiarized, if you like) from the Heritage Foundation. The "individual mandate" was their idea, so that there would be "no free riders." Governor Romney instituted such a system in Massachusetts.
It's a Republican plan, designed to keep insurance companies in the game by providing people who otherwise couldn't afford adequate insurance with subsidies, turning them into millions of new customers.
"Obamacare" IS the Republican health plan. The reason they can't find a "replacement" is that it is already in place. You Republicans should own it, and take credit for its successes.
And for my friend with kidney disease who was able to buy insurance and whose life was saved by Obamacare, for those of us whose first-time health insurance let them get tested for dangerous things that are now prevented, and for the millions of babies born with good prenatal care because of Medicaid and who were too young to make rational choices between the inadequate plans the Republicans today are proposing -- we'd all be grateful to you. Republicans would get a lot of thanks. Think about it.
607
My friend is on Medicare, and has kidney failure. She was told, at her age, Medicare will not cover dialysis, only hospice care for a month or two.
The ACA saved billions, by slashing money for Medicare.
Mr Douthat had a good start: Keep the expanded Medicaid, forget the rest. He then said that what we really need is to slash Medicaid (the best thing about the ACA), eliminate the mandatory insurance, and ...
And we're back to the AHCA. Eliminate all Medicaid, Medicare, and insurance for those without employer insurance.
For those without employer insurance, if they get sick, they get a floe, and what could be better (and allow big tax cuts for the job creators, who really need them)?
The ACA saved billions, by slashing money for Medicare.
Mr Douthat had a good start: Keep the expanded Medicaid, forget the rest. He then said that what we really need is to slash Medicaid (the best thing about the ACA), eliminate the mandatory insurance, and ...
And we're back to the AHCA. Eliminate all Medicaid, Medicare, and insurance for those without employer insurance.
For those without employer insurance, if they get sick, they get a floe, and what could be better (and allow big tax cuts for the job creators, who really need them)?
1
I grew up as a moderate Republican, until they left me, which helps explain why I think you are right on target with your response. Unfortunately, the Republican party has developed such a hatred for Barack Obama, and anything that has to do with him, that they are blinded by everything else. Until they return to being representatives of the people who elected them, we are in a downward spiral.
Wait! Where did the taxes on the wealthy and on corporations, including small business go? Am I missing something in your timid approach, Ross?
I thought the whole point of "replace" was to take $880 billion out of Medicaid, repeal all the taxes on the wealthy (gotta reward those donors!) and pretty much encourage a free insurance market be able to sell worthless policies--low premiums, to be sure, but very little coverage as well.
So I'm not sure where you're going with this. Because it sounds like your cautious changes would be more acceptable to Democrats than Republicans, who oppose the current plan for two reasons. It either doesn't go far enough to return healthcare to a wild-west total freedom and totally expensive proposition--Rand Paul and other conservatives--or it's too cruel for the moderates from states with high poverty levels and large Medicaid populations.
Either way, your 3rd way doesn't strike me as something that will be applauded. It's simply too reasonable and too "bipartisan". Something that Mitch McConnell fears more than anything, even the president,his fractious GOP coalition, or (gasp) the donors who were promised rewards for their campaign contributions.
I thought the whole point of "replace" was to take $880 billion out of Medicaid, repeal all the taxes on the wealthy (gotta reward those donors!) and pretty much encourage a free insurance market be able to sell worthless policies--low premiums, to be sure, but very little coverage as well.
So I'm not sure where you're going with this. Because it sounds like your cautious changes would be more acceptable to Democrats than Republicans, who oppose the current plan for two reasons. It either doesn't go far enough to return healthcare to a wild-west total freedom and totally expensive proposition--Rand Paul and other conservatives--or it's too cruel for the moderates from states with high poverty levels and large Medicaid populations.
Either way, your 3rd way doesn't strike me as something that will be applauded. It's simply too reasonable and too "bipartisan". Something that Mitch McConnell fears more than anything, even the president,his fractious GOP coalition, or (gasp) the donors who were promised rewards for their campaign contributions.
76
The high deductible plans that many have chosen, to save money on premiums, have made many patients, unfortunately, even more vulnerable to price-gouging scams, because individual patients lack the knowledge needed to question whether certain prices are a real value or way out of line -- not to mention the patients are sick, and time may be of the essence.
If there could be means-based subsidies for both the deductibles and premiums, that could help --and tax-free Health Savings Accounts (H.S.A.) could help too. But there also needs to be a consumer-protection mechanism for the deductibles. One could see how consumers need two insurance products, one for their premium-based insurance for major health expenses exceeding deductibles, and another --perhaps a consumer-owned advocacy and price-negotiating product, which could help the consumer keep more of their below-deductible dollars (ideally in their tax-free H.S.A. with compounding growth and interest), while assuring the best value and quality when the below deductible money needs to be spent.
If there could be means-based subsidies for both the deductibles and premiums, that could help --and tax-free Health Savings Accounts (H.S.A.) could help too. But there also needs to be a consumer-protection mechanism for the deductibles. One could see how consumers need two insurance products, one for their premium-based insurance for major health expenses exceeding deductibles, and another --perhaps a consumer-owned advocacy and price-negotiating product, which could help the consumer keep more of their below-deductible dollars (ideally in their tax-free H.S.A. with compounding growth and interest), while assuring the best value and quality when the below deductible money needs to be spent.